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AWaste Tire Sdkey & inspection Rep t SURVEY REQUIRED <br /> a <br /> State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> Callfomla Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - , 1 _ ; Inspection <br /> Site — ' <br /> Site Suffix: Report = 61 <br /> Number: <br /> Inspection Number on the associated Surrey form(Page 1) <br /> Comments <br /> �(,� - `• ce- : cies o� <br /> � 42408 <br /> t; }4 A M PI LI t 2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />