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k <br /> _Waste Tire SL- ,/ey & Inspection Rept SURVEY REQUIRED <br /> "ate• State of California ------------------� <br /> CIWM8183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - 1 1 _ Inspection <br /> Site <br /> Site Suffix: � Report I lL� L✓ <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> NA W <br /> Gait�x KV1C �e v�� 0 <br /> 7 eco`S <br /> G�� � cc_S 5 vias 1 e5 <br /> JE A MIPI LJEJ t 12T31 42408 <br /> White Copy:CIW MB Yellow Copy:Operator Pink Copy:LEA <br />