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_Waste Tire S vey & inspection Rei 1, <br />•••' �! State of California <br />CIWMB183 (New 04/04) Comments Form <br />California Integrated Waste Management Board <br />Business Profile Inspection Details <br />- ® O L Inspection <br />Site — —t ' l� A 1 <br />Site Suffix: Report = /Ijj, <br />® Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />--- -- <br />3. (erns Tc.s, ,s res c <br />'. <br />an,J -�of <br />F A M P L 42408 <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />