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Waste Tire SLL ey & Inspection Rep t SURVEY REQUIRED <br /> �! State of California �ypyo <br /> CIWMB183 (New 04/04) Comments Forn1 - -- -- -- - -California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> t 1 q Inspection 1 *� 1, u <br /> Site 1 2 _l 1 2. 2- ® Report = ` — l L. _I Z —! <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2-)- K CM, <br /> MA <br /> c <br /> - CL <br /> ciA- <br /> 42408 <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />