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L <br /> _Waste Tire SL fey & Inspection Repo SURVEY REQUIRED <br /> • _'! State of California <br /> Mug CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> � <br /> Site Suffix: 1 3 9 /0 o Report I ' — q 5 S <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> w0.S ,mer x�\S <br /> ok <br /> C'e�,�eLJ <br /> V4\ <br /> 42408 <br /> E_ XIA Mt P t Ljej 1 2 3 -� <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />