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Wastee Survey and Inspection Repo. , City/CountyMailing Address <br /> State of California �ti� J vim; a�� �N�..�-. <br /> Phone Number <br /> CIWMB-54(10/03) y <br /> PART D -Notes Page 2—of .-7— <br /> File Number: Inspection Date: <br /> Business/ Facility Name: GPS Coordinates: ! <br /> lrr�h5�i:- �)�5 S`f"D rc.JC !1� Al nC�C7 rTi v.?-✓ �.���r� . <br /> lf4—lo des, r>3 <br /> n <br /> A V <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: <br /> `White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />