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City/County <br /> * . Waste #re <br /> ' Survey and Inspection Report/ Mailing Address <br /> State of California -�j�, G ,,,,.- o �� ��, v�v,'ra,•w�pr-�h f 7C� �f (.- Phone Number <br /> CIWMB-54(10/03) <br /> PART D -Notes Page of/ <br /> File Number: Inspection Date: ,7 (` 11 <br /> V� ''Ca owvt <br /> Business/ Facility Name: GPS Coordinates: <br /> 2-?4c/ f5 <br /> o— <br /> .� 1 G`.C:Z sl r i 'rZ"�:T S G: A C'..1 e✓� 'a-- �/.� <br /> 1 <br /> 0 -7 1 /--F - o <br /> rN1 <br /> Pte / <br /> 12- b el' 9 -- o <br /> s -T s C2 i�� fa - o <br /> Follow-up: <br /> ❑ Letter of Violation ❑ Violation re-inspection ❑ Refer to CIWMB Date: <br /> Date Mailed: Date: <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> Inspector's Signature Phone: ''(b o —Z�TU, <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />