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Waste Tire S. iey & Inspection Ret SUR7E=YRE=QUIRED <br /> "4! State of California <br /> •- CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE_ OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- [ <br /> _/ Inspection <br /> .- 2 Report <br /> Site Suffix: V <br /> Number: <br /> Inspection Number on the associated Survey form(Page 7) <br /> Comments <br /> v <br /> \C, <br /> h <br /> 42408 <br /> JE XIA MIPILIE1 111251 <br /> White Copy:CIW MB Yellow Copy:Operator Pink Copy:LEA <br />