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Waste Tire S�. �e & Ins Inspection Re <br /> --- - <br /> Y h SURVEY REQUIRED, <br /> ■�i3� State of Califomia <br /> CIWMB183 (Now 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- �7 I �f Inspection ,[ <br /> Site Suffix: ` `1 L b � [ o f Report I 1 - ` ` 9 6 6 <br /> -7 Z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> '�-�.v`v�r �e-S _�n��vwc �C�`•�e-C S e�C��-e�S �n.a-S <br /> G- \N \.CCN 52,C K c n, <br /> O- C�� [G '�•�`�, �r ��c>`� ���eS aS2��2�re.0 <br /> -- 2) -%4;�) _C <br /> 42408 <br /> ; AMP LIE! i ' <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />