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..... Waste Tire Surveyand Inspection Report City/County <br /> pecon porMailing Address <br /> State of California Phone Number <br /> CIWMB-54(10/03) <br /> PART D -Notes Page—2--of _2�— <br /> File Number: Inspection Date: <br /> -::, g <br /> Business/ Facility Name: GPS Coordinates: <br /> g- <br /> 3 L/05 51 <br /> L3 - 1 Z_5-1 4-n13 <br /> JP D — DT^ <br /> L-un le A> fl ,A LSC% ctcnemlocs <br /> Je4 C,-I L/J r`1 IS A 01- <br /> -'f-•I I"�r. ,1 JGf! "�,/ <br /> S` L,/'ttS 3-7 G 19? <br /> r <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 Signature Phone: �yv �yC <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br /> 7 ��` <br />