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Waste Tire SL Jey & Inspection Rept <br />"' • State of California <br />• gry� m <br />: CIWMB183 (New 04104) Comments Form <br />California Integrated Waste Management Board <br />SURVEY REQUIRED' <br />BLUE OR BLACK INK PEN <br />Business Profile <br />TPID - <br />Site Suffix: 5 <br />Comments <br />6 , <br />Inspection Details <br />Inspection <br />Report = 1 _ 1 -Z5 5 7 J 3 <br />Number: J <br />Inspection Number on the associated Survey form (Page 1) <br />G.ecer� P <br />o5 �a r <br />aL <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />