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ki <br /> Waste Tire St&ey & Inspection ReptSURVEY REQUIRED <br /> ••�-•: State of California <br /> CIWM81fl3 (New04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> 2 <br /> Site Suffix: ` 1 2 �j - 1 Report I 1 - 1 'Z 03 Z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> C,t Zo! 2p�� �c��lzol 2a� 3 � � - <br /> E�T•5 _bw, �����5 o v�_ � o�w� c-�7 wec� <br /> JE A MIPI LJEJ1 12F3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />