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kaAWaste Tire S fey & Inspection Rea tSURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` Inspection <br /> Site Suffix: 1 O 2 S 2 S , Report I — 1 2 Z L O <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Cj,r� b� Q.V(h.���,�+�0�� �C 'CQ-ya'��l 'COQ 0.►�S c <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />