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® Waste Tire .S.. ,rvey & Inspection Re ( 'Irt SURVEY REQUIRED <br /> State CIWMI "ai `°rnia <br /> New Comments Form - <br /> CIWM6133 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile _ Inspection Details <br /> TPID - ._.}. . Inspection <br /> Site Suffix: I I `i J i Report I `� — l `.J/� - <br /> __ Number: <br /> Inspection Number on the associated Survey form (Page 1) <br /> Comments <br /> . Vlr) t�e <br /> lµ — <br /> 42408 <br /> ■ ! e Y. „ f0. �r P ' 1- E ' 1 2 3 � ■ <br /> White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />