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- City/County <br /> .. Wast"iSurvey and Inspection Re Mailing Address <br /> i <br /> er <br /> tatthon�Numbe of California <br /> IWMB-54(10/03) <br /> Paaa�Zof <br /> 'ART D-Notes <br /> Flle Number: Inspection te: <br /> 12— <br /> Business/ <br /> LBusiness/Facili Name: GPS C rdinat s: <br /> �n <br /> .Q <br /> Follow-up: <br /> ❑ Letter of Violation F1 Violation re-inspection ❑ Refer to CIW MB Date: <br /> Date Mailed: Date: <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> _ - Phone:2Q ;5 <br /> Inspector's Sig ature — T— <br /> e Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />