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J4 <br /> Waste Tire Swey & Inspection Rer I <br /> SURNEAU REQUIRED <br /> State CIWM fC3 (New Comments Form <br /> CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- �-- - --_ Inspection O— --��ISite Suffx: L13-13—L-11 <br /> g Number: �� � <br /> ice6 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> se- <br /> 4VI Al <br /> o►a� ���e, �o_� ao_o� a�� ��1_ -7, ao_o <br /> 10 el o_ _ _ <br /> Oct <br /> (I X R IIM P L 2 2 3 42408 <br /> White Copy: IWM Yellow Copy:Operator Pink Copy:LEA <br />