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Waste Tire S. ley & Inspection Rep tSURVEY REQUIRED <br /> •••�•` St ate 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- c Inspection <br /> Site Suffix: � "L <br /> L ? 5 Report I — 1 ` 6 g 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> X6.2 <br /> c �G r <br /> If <br /> 0 "'AS <br /> E; XIA MIPILIE1 111251 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA P-47 <br />