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On= Waste �ire Surveyand Inspection Repot <br /> City/county <br /> p p Mailing Address <br /> Stgte of California ��;^ ���• ��'� �� `�� �/14'!� O/mA�'�A C�f�� Phope Number <br /> CIWMB-54(10/03) —3c-) L L Je,be.,- f`— <br /> -- C'A qs zv ;7— <br /> PART D - Notes Page -,,,of� <br /> File Number: Inspection Date: 3 11J <br /> Business/F "lit�7( Name: GPS Coordinates: <br /> / il <br /> A <br /> iL2 fc- w e-2.,e_l <br /> a u�►1 � <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 Signaturey <br /> Phone l�—Tt- 2-2 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />