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n <br /> City/County <br /> :. Waste ire Survey and Inspection Repo--i Mailing Address <br /> 1' <br /> State of California ��h�� L—r�v, t�7d��IA— Phone Number <br /> ���`"' ���`'`�°"'�^ <br /> CIWMB-54(10/03) <br /> PART D -Notes Page of Z— <br /> File Number: Inspection Date, <br /> -)/0 <br /> Businessi Facility Name: GPS Coordina es. <br /> F,GJ , mss 4-- -/ -7 5,557 -31-34>L0 <br /> 5 mss -�- ►-,v tea <br /> f r,C1 +-.e C_ le-y- <br /> 4­5 e-y-45 <br /> l <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 SignatureAziZI—­�(adi__ Phone: f't�`�—ZC!�Z, <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />