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■ Waste Tire 4Wey & Inspection R160't SURVEY REQUIRED ■ <br /> L3!�! State of California -- ---- --- <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - (� - V ' Inspection _ <br /> {� Report <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 3) <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />