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® y Waste Tire Wey & Inspection Re °t <br /> " SURVEY REQUIRED : <br /> m■�..:. State of California _. <br /> 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 /> - — -- <br /> TPID- Inspection <br /> Site Suffix: - / Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �� � 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />