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n Waste Tire Sjfey & Inspection Rcep SURVEY REQUIRED <br /> L�!!'_'�! State of California <br /> CIWM6183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: J <br /> �` Report = f e ` <br /> L.J Number: ` " <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Id <br /> -Lv CM-L a f/Yao VSD Vi..�—cC� . <br /> IE XIA MIPILIEI 1112131 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />