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UNC UR ROLINt r Si(-)KA TAW <br /> �2f ti1t�1�k�TEFJ lrhdl E `c, tiC UtVi3 S1`t� 1lyE 1`ANK OPERATOR�J151.1AI,INSI�t�-(I iQN EtFI't�FtT:tSTT. L tt�� <br /> 10180561 <br /> F SCAB ON°MINI MART <br /> iW11-.—m- <br /> 109Z E. YOSEMITE AVENUE <br /> r�-#'' `mow.. >:� .. Print as slroart the► .. <br /> rVr Le�r sryrtsfaTi il&T C> talar( #t PAorm# <br /> Zane Nimmo ( 09 74 X11 <br /> V;C& R"Von f Y �'� tcG C-14"00at1aaL )Cplil4tl Cr L�a4rs� ' <br /> �W. <br /> aruruets or'rv'cat W4 #1 sett i+catts i/JJ Jhr or h JCJ rrwst 4®r Oitp Oed k)thJ;4 soc6on and may r vWkV -srp <br /> 1 _ <br /> 3. .a, . <br /> 1 % <br /> 7. <br /> 3. <br /> a <br /> �2. <br /> 161TWt—tma }; <br /> I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations, 71t1e 33, <br /> { Diviaron 3, Chapter 16,Section MG and all the information provided herein is accurate. <br /> I Ck_i nate l U&T Operator Signature <br /> !,,ss:r�s hsr:cf{��n Secfiorr 1J;ataov !ust he�#J�description o [ltT'�r pc�n taken ar to 6 tskerl io otN( i`t the r5s etA <br /> ��':E'(t►at i�017@SJ?C)l1dS WIi1J fh�r frtlrl7t?$(ltlJp Ol`iJZ6�OrarpJ?ETnG�FS�tIB (1Jlt?f�8l?OVc'(Il Sr?Cit0r1 111. <br /> F <br /> s .2. <br /> 4. <br /> b <br /> 1 7 <br /> r 8 <br /> I9. <br /> 10. <br /> , <br /> 1 <br /> 122A7b�tyAG1 LED <br /> r � NCJW b,. <br /> H <br /> x r- <br /> t T,ISCUMM <br /> ave reviewed Section III"COMPLIANCE ISSUES"and providod a duscrrptiOn 1 <br /> to correct the 6_Issi discovered, <br /> +J�r �ll <br /> I"FuS1 Ownerl0perator{Print} U:si r�:r,cai lj}lttT+leu ;;,,ir,c,ttaiG r.`„t ;lrt <br /> f= >�•iinrnrr Etnirr7rYtrurlfai b}+srrt,ll)T Itk�rUhrtiun;Litt i >tl�nnxnl`x,xkttle, <br /> a P <br />