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k <br /> :Waste Tire S . ✓ey & Inspection Ret SURVEYRE•°' State of California <br /> _ CIWM8183 (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: _7 Report I — Z O 2- / <br /> 0 l O I Number: I 1 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 04 <br /> L# eqar coag 5�2 <br /> 5Af 41 <br /> 1EXI <br /> A P I E 1 1 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />