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City/County <br /> ... Waste .re Survey and Inspection Repo, Mailing Address <br /> State of California <br /> Phone Number <br /> CIWMB-54(10/03) <br /> PART D - Notes Page <br /> File Number: Inspection Date: <br /> 31 n <br /> Business/Facility Name: GPS Coordinates: <br /> �,.J f�„ •-FBF,`�- � w. G.I !1i►-+� � �a..�. <br /> r.i -• co. da 6 c a lr�va��crcX 1� <br /> a <br /> 500 LoIL S elk 41;irl� 'I.9 1 4� C,rj a <br /> 1 It 4!:y r ka+n le, 4r-,J,--S 1 <br /> C-;L V-- '2or 4-1 -4l �� qc� <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 � t Phone: (J J 2,'51 <br /> bC� <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />