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_ Waste Tire SL__ ✓ey & Inspection Rer t SURVEY REQUIRED <br /> •"�: State of California C <br /> • CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> QZ - Inspection <br /> � <br /> _ Q <br /> TPID- Report = 1 <br /> Site Suffix: 1 V S <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ems. l• - G— <br /> c epi�r � (n5Cy'aine, <br /> Cal <br /> ))r;�% ZMZ,—'% �!7 <br /> 42408 <br /> JE XIA MIP! LJEJ 11 12N <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />