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XWaste Tire S`Uey & Inspection ReptSURVEY REQUIRED] <br />--� State of California <br />New 04/04) Comments Comments Form <br />CIWMB 183 ( <br />California Integrated Waste Management Board BLUE OR BLACK INK PEN _ <br />Business Profile Inspection Details <br />Inspection Repoli ` <br />Site Suffix: 2 l - 1 I 1 - { S I <br />Number: J <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />l <br />?i <br />yj2G05, <br />42408 <br />A M P I L 12i3I � <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />