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r Waste Tire Srey & Inspection Re -t suRVEYREQUIREp`I <br /> ,-T::_ <br /> State of California _ <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile: ,w: Ins ection Details <br /> TPID- — Inspection _ <br /> /� - <br /> / P <br /> Site Suffix: ' I �' ( Number: , <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1),C.,\ l� C; i <br /> --r � <br /> i 1 I <br /> Ty r1 _L .) -t <br /> — <br /> r <br /> 42408 <br /> JE XIA MJPJ �Jej III <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />