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_ Waste Tire SL ✓ey & Inspection Rer, .t SURVEY REQUIRED <br /> •�• State of California I -- <br /> CIWMB183 (New 04/04) Comments Form - <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 Report 2 , — r 2 5 ' 67 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Tq <br /> `r <br /> aS)crat mar �►$S/ .�S�a � <br /> cc <br /> 42408 <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />