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:_Waste Tire Si ey & Inspection Rep --t <br />•"�': State of California <br />CIWMI3183 (New 04/04) Comments Form <br />California Integrated Waste Management Board <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID - <br />Site Suffix: I I <br />S <br />Inspection <br />Report <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />4 <br />C A <br />C/3 /J, lS )�7' � �at /000V-7 <br />/ / <br />bs � <br />oU Gf V LiL� �' 641CAJ& i A=6�l- <br />40 <br />Aj / ,A 0 <br />J L <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />