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. •••a.r Waste Tire S*jey & Inspection Rept '�sURVEY REQUIRED] <br /> State of 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 Cj <br /> l7 D G 3 I Report = 1 <br /> Site Suffix: v ✓ l Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> K50 -S�. X17 ce o� -t rnot/\-r— Ts 150 ;r 'M� c <br /> 2. Min\\CoCS 9rnyy\ !(` -V® C- e Y,-L <br /> 0- 6 C-a.k % a Y\ . <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />