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Wastea Tire SL rey & Inspection Rep t SURVEY REQUIRED <br /> !!111! State of Californi <br /> CIWM- (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- n ` Inspection 1 u p� p <br /> 3 5 � 5 5 V 1 Report I — 1 2, —1 Z O O <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Av,o OVAL, <br /> jEXjAMjPj �JEJ 111Z73 <br /> 42408 <br /> ■ White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />