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_ Waste Tire 'S y & Inspection ReSURVEY REQUIRED ■ <br /> •••a{.. State of California <br /> CIWM6183 (New 04104) ments Form to <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspection <br /> Site <br /> Site Suffix: f �J �• t Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Jo <br /> ,. JE <br /> XIAMIPILIEI 111 <br /> 42408 <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />