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:Waste Tire S vey & Inspection Rer t <br />' -_••• State of California <br />CIWMB183 (New04/04) Comments Form <br />California Integrated Waste Management Board <br />Business Profile Inspection Details <br />SURVEY REQUIRED ■ <br />BLUE OR BLACK INK PEN <br />TPID - // Inspection <br />Site Suffix: / Report <br />Number: r T U <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />1U, - . <br />-- 1t)(n s <br />SOT <br />1 <br />White Copy: CIWMB <br />[e.XIA MIF <br />Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />