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:- Waste Tire S, ✓e & Ins Inspection Re °t <br /> - - , p SURVEY REQUIRED <br /> ••'� • State of California <br /> ---- Comments Form <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Q G Inspection �7 <br /> TPID rt 5 C� V O 1 Repo = 1 — ` Z c) z / <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ` Comic Vtka co>A- tis Oc�S �y� e S c <br /> vyn.o_Y.;� a p <br /> pv�� s-eS i N`S L a-5 <br /> --- <br /> 42408 <br /> r � <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />