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:, Waste Tire St ®e Inspection Re t <br /> - _ <br /> p p SURVEY REQUIRED ' <br /> Si7t�' St ate of California 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 /> TPID- 1, t inspection <br /> Site Suffix: _1 g lJ ® 1 Report I 1 _ t 1 q z s 1z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> le XIA <br /> c - s <br /> 42408 <br /> htiP I3 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />