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Waste Tire S*vey & inspection Rei 't SURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: C / Report I — z 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page <br /> Comments <br /> �.AT/> -pro <br /> and <br /> 1 <br /> O,vada t,q- lam- rj2u <br /> 14) A[( <br /> 42408 <br /> JE XIAMIPILIEI III <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />