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_ SURVEY REQUIRED <br /> Waste Tire S wey & Inspection Rer �t <br /> State of California <br /> CIWM6183 (New 04104) C umments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> 2 G; Inspection <br /> Site Suffix: <br /> .7 r y Report <br /> Site <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> V C�—Ili 0 ^^_s @at' ct�►•Tc�' Z7•F C on C�,o-y`► <br /> JE XIA MJPJ �JEJ 111Z3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA PT <br />