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::__Waste Tire SOey & Inspection Rer 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 /> TPID- Inspection 1 <br /> Site Suffix: 1 J Li 1 Report I ` — Z 1 C) 3 q <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> JE XIA MIPILIE1 111273 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA P—T <br />