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Waste .,ire Survey and Inspection Report City/ county <br /> 3' p p Mailing Address <br /> Phone Number <br /> State of California <br /> CIWMB-54(10/03) <br /> PART D -Notes Page *2--of�–• <br /> File Number: Inspection Date: <br /> Business/ Facility Name: GPS Coordinates: <br /> t rr� <br /> '1-- <br /> �\ V'�J'f' 4- <br /> 1; <br /> 1 / <br /> 5 LA 5 41`k'P5 -742%c-k cX V-, 0 i t G W <br /> �o 4- cl cess f <br /> l-2- l-JLC A-- h O 1 I Cx STG•/�1h-s <br /> �l,✓C. 1 h Qi 'e.Pir. <br /> _77,5 ,C:kC <br /> l D t4 <f- J <br /> G 'vr <br /> Follow-up: <br /> ❑ Letter of Violation Violation re-inspection ❑ Refer to CIWMB Date: <br /> Date Mailed: Date: 2-110+ <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> 7 , <br /> Inspector's Signature !� �Yi Phone: �� �b <br /> 11,41 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br /> rec 'j by : <br />