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AWaste Tire S( rey & Inspection Rept SURVEY REQUIRED <br /> •::=: Stateof California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: n Report I — ? s d <br /> 1 ` Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Tt <br /> r.G_cek5- <br /> JE <br /> APIA EI 111273 42408 r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />