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.-AWaste Tire <br />SAey & Inspection <br />Rept SURVEY REQUIRED <br />•■'1*: StateofCalifornla <br />CIWMB183 (New 04/04) <br />Comments <br />Form <br />California Integrated Waste Management Board <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID - t 1 <br />Site Suffix: 1 <br />_ <br />'inspection <br />Report <br />Report <br />= I — ' -z-5 © 2- 7 8 <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />C, <br />ktz <br />C, V\ <br />kAl <br />42408 <br />1EXIAMIPILIel III <br />,lnil <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />