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2 <br /> r i <br /> Waste Tire SL&ey & Inspection Rep SURVEY REQUIRED <br /> ■ ��^: State of Ca(iforma <br /> CIWMB183 (New 04104) Comments Form <br /> H, Califorfiia Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> r" <br /> Business Profile — - - <br /> , Inspection Details <br /> TPID- `" Inspection <br /> Site Suffix: <br /> Report I - 1 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - <br /> !- - �:� Imo, -� r f' _ ., t--.�4 , . �•- <br /> 101 <br /> -C ii -"1 <br /> � C <br /> i. <br /> le XIA M J PJJ JEJ 1112131 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />