Laserfiche WebLink
• - <br /> Waste Tire Survey and Inspection Report City/CountyMailing Address <br /> -••• Phone Number <br /> ate of Califomia <br /> NMB-54(10/03) <br /> ART D - Notes Page of <br /> =ile Number: Inspection Datb: <br /> ,z _ —Oi-) <br /> Business/ FacilityName: GPS Coordinates: <br /> 0 <br /> -71 <br /> i <br /> wr �/�S YGTT-r�C <br /> y S <br /> oC9 alk <br /> t <br /> \ 11 0 <br /> r- � �� <br /> A <br /> Follow-up: <br /> E] Letter of Violation ❑ Violation re-inspection ElRefer to CIW MB Date: <br /> I Date Mailed: Date: <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> Inspector's Signature Phone: ,pcl - 15 3-76y 8 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />