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ste Tire S vey & Inspection Rer. tState SURVEY REQUIRED <br /> ...�y. CIWM ofCalifornia ) 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 /> TPID- t Inspection <br /> Site Suffix: ` 2 ,n 1 Report I 1 — a 3 <br /> 1 V 1 Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> J v <br /> 0�1/eA � ��n . �"�31 wvll to 9j <br /> If; XIA MIDI LIEI I r 12131 42408 <br /> t <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />