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:_ Waste Tire S vey & Inspection Rer ^t SURVEY REQUIRED ' <br /> •••�`• State of California <br /> - Comments Form <br /> {u CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN _ <br /> Business Profile Inspection Details <br /> /� ('� Inspection <br /> Site Suffix:- ` �1 lJ 3 1 V I Report = 1'7 <br /> Site @ [ w <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 6?s. C, UA 0 �17C)L <br /> t <br /> D s 1 eT f 7 _�. �S (A,t2,, <br /> VA Go ,. <br /> A� <br /> 1 <br /> m Uv�� <br /> DLe-A WnA.4 <br /> 42408 <br /> � � R � F � � � � 3 Is ■ <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LFA <br />