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* Waste Tireey & Inspection Rej# SURVEY REQUIRED <br /> State of California o m m e n t s Form <br /> • CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile I JW. Inspection Details <br /> / Inspection <br /> Site Suffix: r3 (J �. �VI ! Report <br /> T� Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ti 6 �xn ' .5 61 <br /> V- ✓h t.._- :�� T :=� ��i.n_T r,_ r c� r - <br /> ,I <br /> i <br /> I <br /> II <br /> I <br /> II <br /> i <br /> — <br /> --r 41- <br /> E XIANP L ��2 � 3 4240£ <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />