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Waste Tire Bey & Inspection Rei -t SURVEY REQUIRED 1 <br /> .�:. <br /> State of California <br /> wagsy CWMB 183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> L <br /> Site Suffix: l T 2 q Report I l — ' 7 <br /> Number: <br /> Inspection Number on the associated Survey form(Paye 1) <br /> Comments <br /> �'�� tcs�s /1�•�v s eZ 5 <br /> 1---' <br /> 4i rc, p,-c le -,LZ/0 lck.c 5- f)e4-r,.Iez�/ <br /> JE XIA MIPILIE1 1112131 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />