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:Waste Tire S ey & Inspection Rer tSURVEY REQUIRED <br /> •�•iH State of California <br /> CI - - --- (New04/04) CoUmments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> C - Report = <br /> Site Suffix: � � � �- � � (� � — � ` (} '�' .� I T <br /> j Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> I L iy �L R �x-3-5 y_—_shna.�qk 6� wct yi-c -f;2s o1�=,=, <br /> DI��� Lt�!i((,� i'nG�t,LC,���'�ckl G'�/rCc G,tcS 6t� -►4'� S <br /> Gc t �i� k'C C!:L_S�U <br /> A/C "T 3s' 3(a 1 <br /> Ili tM&K}-2 --H RS S (10—U kar_n OL w.c. V"nznr <br /> 6 2 eA r,, ayick <br /> -0/0 <br /> R&C1 k' earl Ct�rLclC A4- KCS 4n - <br /> 00 ss,"hCG vcc�fzrr �"S sr cc c . <br /> 42408 <br /> White Copy:CIW B Yellow Copy:Operator Pink Copy:LEA <br />