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............ .... <br /> ------------ <br /> N <br /> Waste Tire S u rvey & Inspection Report SURVEY REQUIRED ■ <br /> State of California <br /> CIWMB 183 (New 04/04) Comments Form BLUE OR BLACK INK PEN <br /> REQUIRED <br /> California Integrated Waste Management Board <br /> Inspection Details <br /> spection <br /> inspection Details <br /> Business Profile <br /> n <br /> inspection <br /> TPID- Report <br /> Site Suffix: <br /> ix: Number: Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> V <br /> A) <br /> 4a 11h- <br /> 42408 <br /> JE XIA MIP1 �1gLJIL <br /> White Copy-.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />