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m: Waste Tire <br />W•••'`• State of California <br />A CIWMB 183 (New 04104) <br />California Integrated Waste Management Board <br />SL ;ey & Inspection Rep, Y <br />Comments Form <br />SURVEY REQUIRED) <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID - Inspection <br />Site Suffix: 6 ' ` Report I — ' 1 a O S <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />1.18 `- �• 'fir oui�\,��� (,.� r `( p(`c c LAE,-\& <br />0(1yam,_ <br />S�� , �-o Vie- l�w�;•�� SI_e�.-So°n 4 (.,.��.�c�., o� <br />or 100, <br />1EXIAMIPILIE1 Ill! <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />