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Wastea Tire SL%y & Inspection Rep SURVEY REQUIRED <br /> State of Californi <br /> ■ CIWM13183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: Q � Report ` 6 t+� Q � Number: I 1 �- <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ju;1 Vt 4,� inn <br /> 14h) wo IGe -i�11/�c qty Ci/1?�rC C Cc�✓►�^ r,�, - <br /> �Vnkc� <br /> 42408 <br /> e XIA MIPILIE1 1112131 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />