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: 0904900021 <br /> Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> ■ .:::. � State of California ■ <br /> CIWM8183(New 04104) Comments Form - <br /> CafifomlalntegateaWasteManagementBoard BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- t Inspection <br /> Site Suffix: J 0 , Numb er: I I - D 8 8` a ( ' <br /> Numb <br /> Inspection Numberon the associated Survey form(Page 1) <br /> Comments <br /> - <br /> tfso <br /> 70 =Favi 1 I - <br /> ocej - - - <br /> L <br /> OOFplacevn a w - d?F isms <br /> 113o aq <br /> 42408 <br /> . t:'XaIMP LE 1 z3 � ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />