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Waste Tire Storey & Inspection ReptSURVEY REQUIRED <br /> ••"�' State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- G Inspection <br /> Site Suffix: 8 Z ` J 61 Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> YN <br /> C=z — <br /> JE XIA MJPJ �JEJ 111273 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA FOPT <br />