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=_ Waste Tire SI ✓ey & Inspection Rep t �URVEY REQUIRED <br /> • •'�: 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 /> Inspection <br /> TPID- (_ Report = /J /L 2 -S <br /> Site Suffix: d Number: 8 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> S <br /> A� <br /> LII <br /> 41- 1�n �� 3 5no J-IF. XIA - <br /> eAAA-L4 <br /> Y' 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />