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:Waste Tire Wey & Inspection ReSURVEY REQUIRED <br /> ••"''• State of California Rot <br /> CIWMB183 (New 04104) mments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- u Inspection <br /> Site Suffix: 1 5 -1 cj 5 O ` Report I ` — 1 2 Li -z— <br /> Number:Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 3.) A-5- <br /> e XIA MIPI LJEJ 111273 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />