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_Waste Tire SL /ey & Inspection Rep SURVEY REQUIRED <br /> •••°.•• St ate of California <br /> CIWM13183 (New04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 0 3 7 O C3 O Report I — 1 2 2 2 5 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �1 ��3 a 2 C'Cus <br /> con• �i�ow.coc�- �c, c,: � S __ S 'CLS <br /> 42408 <br /> JE XIA MIPILIE1 1112 31 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />