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ka <br /> :Waste Tire SL&ey & Inspection Rep t SURVEY REQUIRED <br /> State of California -- - -- _--- <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID <br /> Site - 1 �y rt m ® Inspection _ <br /> Site Suffix: vx L Report = "(` <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> a AIN <br /> 6C-C401 <br /> \\ _ <br /> 3S VP—CeN <br /> Ck_ <br /> JE XIA Mjp -�JE: 112131 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />