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_ Waste Tire Sy & Inspection ReK._ _ SURVEY REQUIRED . <br /> •••'�! State of California 1 - - _ ._i <br /> } CIWMB 183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile I <br /> I Inspection Details <br /> TPID- Inspection �^'� / <br /> to <br /> Site Suffix: a ® ! - Report = _ 1 Li 2 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> S •' <br /> �►-C- <br /> OF <br /> 42408 <br /> !:'XjA'MjPjLjEj III2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />