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r <br /> .. Waste ire Survey and Inspection Repo, t City/county <br /> 3' pp � r Mailing Address <br /> State of California c�— ,c�'^��'^ �k� r ►�""ei Phone Number <br /> CIWMB-54(10/03) <br /> PART D - Notes Page_':�I­of 2�— <br /> File Number: Inspection Datp: <br /> L-,4-//-1 <br /> Business/F cility Name: GPS Coordinates: <br /> n '.•... 1 ��J Us�� frf,�s c• M'L <br /> G i, <br /> C7v.Fj i <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 /> 1 � J� <br /> Inspector's Signature ? Phone: � — � � <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />