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Waste Tire S & Inspection Re t <br /> , ✓e Y 1� K , SURVEY REQUIRED <br /> State of California <br /> ---- Comments Form <br /> CIWMB 163 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: Ll G� L� o L Report I /J — /� `7 6 q <br /> G Number: .c— <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ilkc��iy�l� �yL nucytn lot ecz�> COOL <br /> A]a6-s <br /> J-410,IL I t ,J, Jo 4ne�� c-) cam1/ <br /> JUkecsFe-x1A MJPILJE- � 11 2131 VZ <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />