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�e. Waste Tire S*rey & inspection Rei t <br /> I 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- Inspection <br /> Site Suffix: S 1 0 Report = _ 2 S s 9 9 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> X!& Pies tn� n <br /> -1 $-\ raCnlw\ C'\ftVl'C <br /> N., � . <br /> c+lrt a r c 2r q— <br /> (-ems �<S _ CJL cs< < VC,CLr <br /> Asti S le <br /> XIAMIPILIEI 1112131 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />