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and Inspection Rep** City/County <br /> Waste fire Survey a p p Mailing Address <br /> Phone Number <br /> :ate of California <br /> IWMB-54(10/03) <br /> ART D - Notes Page �� of <br /> File Number: Inspection Date: <br /> i /%5 a <br /> Business/Fac ili Name: GPS Coordinates: <br /> 0 <br /> >M >1 <br /> b3 o+� a✓� Gin G8 <br /> A 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 /> Phone: <br /> Inspector's Signature <br /> oZ�F f53'76��3 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />