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Lzzq� <br /> Waste Tire S. ✓ey & Inspection R% t SURVEY REQUIRED <br /> State of California Comments Form <br /> CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - I 7 ` RepInsort Site I I I <br /> Site Suffix: - 1 Re ort <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> of <br /> va4ve.E <br /> ,nSvc� Cszt�c�e- py\. our�� S� <br /> GecJe�pis r \ c '3 <br /> V=CA C—SA.7-_CV\k'q 5_�(,Je�s Vrs re-'s <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />