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Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> State� �—, nia <br /> ClWM f183(New <br /> Comments Form <br /> CIWMB 18](New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection �I <br /> Site Suffix: I j Y q g Report <br /> L <br /> 1�� <br /> — I r I o 7 3 3 y <br /> Number: I <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �u5 hcvf reht d-:ed anL mani�s+ a Ufi v-J <br /> TirZ�at (nfDrM� ii7�l Cieam MaP 4 ian�,1`on, 7- <br /> F��e,�,S_o rte' ne�P i 5_— a _). Belo c S a r ✓i clf two-ns <br /> noted . <br /> - a3J- <br /> I <br /> E I x A IM P L E 2 2 3 42408 <br /> ■ White Copy.CIWMB Yellow Copy.Operator Pink Copy:LEA © ■ <br /> �I <br />