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Waste Tire Survey & Inspection <br /> 6aa4�� State of California <br /> CIWM6183 (New 04104) <br /> Comments For <br /> California Integrated Waste Management Board <br /> LUOR BLACK INK PEN <br /> pIp_ Inspection <br /> €te Suffix: - l Report m --� <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> 4 <br /> z. <br /> t <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA IN <br />