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L <br /> :Waste Tire s -ey & Inspection Rept 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- - 1 Inspection _ <br /> Site Suffix: O © l Repoli I 1 ` s 7 <br /> Number: r <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 5 <br /> JE XIA M[PILIE1 111273 <br /> �• `r e�.\\ `,,mac,--s�- ��.�c ��n���-� <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />