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■ _ Waste Tire 41&ey & Inspection R t SURVEY REQUIRED <br /> C ■ <br /> HiB IWMIof IWMB 183 (New 04!04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- i Inspection <br /> 1 S O Report z . — �, . 'J, U 7 3 <br /> Site Suffix: J Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ; Fuc,I <br /> J <br /> nvrYl Ul*�1��61 '�Ll— 1�s� m s LA,'Q&r' <br /> C�o I nit, <br /> 1 COMPLETE THIS SECTION ON DELIVERY 7009 3410 0001 8274 7384 <br /> ■ Complete items 1,2,and 3.Also complete A. Si atu -7) v a o n a <br /> o-,; <br /> item 4 if Restricted Delivery is desired. ❑Agent `� c 1 m <br /> ■ OS M in <br /> Pr'n our,p me n ddress on the reverse 11 Addressee ° m � 0 . <br /> s t r the card to you. ag • <br /> Re eived by rimed N e) C: Date f livery n— <br /> ■ AId t h back of the mailpiece, N W a g m <br /> or on the front if space permits. <br /> f'f = 5 <br /> O c T m T T <br /> D. Is delive i Yes Z C. • <br /> 1. Article Addressed to: ®� 210';0 O � m <br /> v If YES,a b o No :3 03 fa <br /> T.r. <br /> Jerold Brannon DEC 0 7 2010 n o o c , <br /> Brannon Tire N ' w ®' <br /> 3750 N.Wilson Way <br /> Stockton, CA 95205 3. s1e ice Ty a FEP#R/SERVICES <br /> Certified Mai Express Mail <br /> /P—Registered ❑ Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> CD <br /> 4. Restricted Delivery?(Extra Fee) ❑Yesv r� <br /> 2. Article Number <br /> (Transfer from service/abl 7009 3 410 0001 8274 7384 <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br /> a <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />