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Waste Tire vey & Inspection R rt SURVEY REQUIRED <br /> •••moi_ State of California <br /> CIWMB183 (New 04/04) mments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Inspection <br /> Site Suffix: I 7 J p '� Q ® Report I I I 2 / g d <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> JEXJ <br /> A MIPILIE1 1 12 3 42408 <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />