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Waste Tire Alvey & Inspection Ret 't SURVEY REQUIRED <br /> State of California -- ---------------- <br /> CIW MB 163 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection u <br /> "\ 1 ® Report I —) <br /> Site Suffix: Number: 3 ® O <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments — — - <br /> ` <br /> we., ck j � c���,ir a ,IKA) . <br /> Cj 1L., <br /> Uf !A nom, �s <br /> CN f,s?rur� MtXh N542408 <br /> u <br /> le A MIP11LIEj <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />