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Waste Tire SfPvey & inspection Rer._. t SURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- y Inspection <br /> Site Suffix: ! -I S /S ,0 1 3 - O ` Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Nc7►GS t _ P1 G ,�i CSA r c��1s k�s p�S"t_P!� lx l/�,l n `��IQ iU�1 tug <br /> S ) EL i vac.. i Q-A l X•�S�"e� 'fes �. - <br /> L <br /> L <br /> • S ��lGS s0l_A (kfc-ia4?x -4�c_ J� f ttS1ls��+rle.r' <br /> ♦ln,1/lt�� <br /> 5 TV(c.S (1 j,-A QA)�A <br /> '� �` 1�M�n l� ` ► 1�T' ,M til�q�'GS�S M 1.�3"f �t, rc.I G�� <br /> JE XIAMIPILIel 111273 <br /> 42408 <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />