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Waste Tire SMey & Inspection Rejo SURVEY REQUIRED <br /> State• r ornia <br /> CIWMB 83'f(New04/04) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: - Report <br /> Number: r <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 42408 <br /> JEJ 11 ; 213] <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />