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Waste Tire fey & Inspection R%t <br /> .3S..i Slate of California m <br /> - CCIWM8783 (New 04104) mments Form r <br /> California Integrated Waste Management Board BLUE OR BLACK CNK PEN <br /> TPID- ) Inspection <br /> Site Suffix: Report I <br /> - <br /> �- Number: -•--'�— <br /> Inspection Number on the associated Survey form(Page 1) <br /> Com ent <br /> vv, o t e. to ' h2 <br /> 7 L- J h n Ve <br /> to <br /> 42408 <br /> JE:XIA MIP ]EI, 1112131 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />