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Waste Tire <br />•"'y' State of California <br />CIWMB 183 (New 04104) <br />California Integrated Waste Management Board <br />S*vey & Inspection Rer A <br />Comments Form <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID - Inspection <br />Site Suffix: i j l � � C j Report I 2 — /i � 'Z -1` 0 Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />ack <br />n "a/1 c! jam' � 1 .MiO .— <br />-1-3 <br />_ lla2 iM�n.th iT 0 A h ZIC 9'U12"C <br />Aj'jr✓n ref- c s y C I/�t t l e.6 _4- <br />II11 , M Imo_ <br />le A M P11!M-3 <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />