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lWaste Tire Survey & Inspection ReportSURVEY REQUIRED <br /> •::��• State of California I- <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - ? 7 6 Inspection <br /> Site _ <br /> Site Suffix: g � Repor 3: 2 <br /> , 5 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> G Ct7�ki - -\kq-- S �i C�2C <br /> t LJI�Q•Si :`^ �� �"(���P - <br /> cee <br /> 1z� JAA <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />