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ii I <br /> City/County <br /> -.. Waste re Survey and Inspection Repo, L Mailing Address <br /> State of California c��,r. "y LrV vDnmP.r.f�.I i9e,_J44._C�I—Phone Number <br /> CIWMB-54(10/03) —� <br /> PART D -Notes � ��^ C q X15'2 z> Z Page of z- <br /> File Number: Inspection Date: <br /> -3f`6 CL+ <br /> Business/Facility N�rr e: GPS Coordinates: <br /> ate ltbLji '5 ' <br /> 4; ,f— <br /> ' +11 <br /> a C_��'-� tit � '�S <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 +� /ax ✓� Phone: (� ) W9 <br /> —r <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />