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Waste Tire Survey & Inspection Report sURUEY R IRe.o <br /> ■ ••'e State of Celifomia ■ <br /> CIWMB 183(Now 04104) Comments Form <br /> calitornia Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ty-y -^� Inspection I�►I �� /`� yn <br /> Site Suffix: Report <br /> Number. <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �ieV' I`I�iD# iS l�`f 9 q2-&- 01 . +rtk� t <br /> CELS a�o���DT v1lLtwi�eys _ D s Vi wed J�r 126M <br /> Nay.io 1a-K" s:ynofi _ <br /> r.. <br /> E B x A IM P L E 2 2 3 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA © ■ <br />