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Waste Tire Sdkey & Inspection Rep t SURVEY REQUIRED <br /> State of Callfomla — - <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details I <br /> 2 1 /� Inspection C� �y <br /> Site I 7 / L 7 Z V I Report I - I I <br /> Site Suffix: <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> � Ir-\e, �r•�es axe- <br /> JE <br /> seC XIA + 42408 <br /> IPILIel 1173 Ed-, <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />