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Waste Tire SL%ey & Inspection Rep t SURVEY REQUIRED] <br /> �••'•: State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID- 7_ ort y+ <br /> I — Report <br /> I 1 o' <br /> e V f — ` <br /> Site Suffix: v I Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments —— <br /> Simi <br /> -T- A.� ' <br /> 42408 <br /> JE XIAMIP L 1 2 3F-eh <br /> White Copy:CIWMB Yellow Copy:operator Pink Copy:LEA <br />