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1,.--AWaste Tire Survey & Inspection R% J SURVEY REQUIRED ■ <br /> ■'■'•■ State of California <br /> W - --- - <br /> swill CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspec- - tion Report1= p O <br /> TPID- � � r � I,l � Report l <br /> Site Suffix: U "` � ® B Number: � _ <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 5 <br /> + Q,4-wa .lr f <br /> Ilt <br /> Oq <br /> C,aL_t.�k <br /> - I t <br /> yr -- <br /> 42408 <br /> JEXIA MIP L - 1 23 ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA 0-2 <br />