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:La <br /> _Waste Tire S vey & Inspection Rer 't SURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- I ?� I l g _ I Inspection I _ C <br /> Site Suffix: V Report , I 2 S J g <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> C Q�� �i C—G•$C— 1 S O <br /> 2. <br /> SIN, Nbo�o)r�-Stsks <br /> ��——�� 42408 <br /> � }� � hhP� L (s 1 2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />