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:Waste Tire grey & Inspection ReK t SURVEY REQUIRED <br /> •••'`• State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- � Inspection <br /> Site Suffix: 3 lX 0 Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> I� T-Pj ,cams ., <br /> - s c <br /> -- aJ7 �7t'k .o f Dccct.&-yi <br /> JE A M P I E I 111273 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA L!iiid <br />