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UN: Waste re Survey and Inspection Report` <br /> City/County <br /> ... Mailing Address <br /> State of California `s �� u �,�-'y �ru �/v ` ( Phone Number <br /> fitt <br /> CIWMB-54(10/03) <br /> PART D -Notes Page -2,of Z <br /> File Number: Inspection Date: <br /> Z ,ZuC <br /> Busines Facility Name: ii GPS Coordinates: <br /> ' s ar. e— I `7 %tel $.3i <br /> as e, �¢ TG C�ICc i cD <br /> lcp v.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 SignaturePhone: <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />