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L <br /> _Waste Tire S dey & Inspection ReK .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 /> Te I Inspection <br /> PID- _ f <br /> Site Suffix: 7 3 � - Report I IV <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> N &c_ a �C.�`v S SC." U J S S O l <br /> �1 J )t�A ACACW rA �I J`l '{Sot", <br /> 4-�L►�n p}y_i (fV tA)lk�,lJE XIA M[PILIE1 111273 C. <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />