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Waste Tire Ss ✓ey & Inspection Rer t SURVEY REQUIRED <br /> °!•• State of California <br /> CIWMB183 (New04/04) Comments Form <br /> k <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - , r o © Inspection <br /> Site — <br /> Site Suffix: b 3 Report = 1 1 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> It <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />