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AWaste Tire SL . ey & Inspection Rep( [SURVEY REQUIRED, <br /> ••'��: State of California - --------- <br /> CIWM6183 (few 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN _ <br /> Business Profile Inspection Details <br /> TPID- n inspection U <br /> Site Suffix: 6 _I Z Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> , <br /> 2,). <br /> 42408 <br /> E XIA MIPILIel 1112 3 �h <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA r� 1 <br />