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J. <br /> Waste Tire SL+ey & Inspection Rep f SURVEY REQUIRED <br /> lriu: State of California <br /> CIWMB183 (New 04104) Comments Form <br /> Callfomia Integrated Waste Management Board _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspection <br /> Site Suffix: Report '5 A <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments. <br /> \I\G.`�c X;, ,, C`,,Z <br /> GS \.C. ,-o <br /> + 42408 XIA <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />