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jamWaste Tire 9&vey & Inspection Rer A SURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New 04/04) (,comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: /� /� Cl j 0 T Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> f{ S <br /> �. � l�� "s-� ,/c!-r G'yt s� Xy, Av4 rf[, 4;;IYP <br /> 101, J <br /> JE <br /> 42408 <br /> XAPt_ � 2 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />