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- Waste fire S e Inspection Re 't <br /> '--- Y p � SURVEY REQUIRED <br /> -;;;14• State of California <br /> -- Comments Form - <br /> CIWMB 163 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> Site Suffix: Report 1 ' 'z -Z O 6 6 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1EXIAMIPILIel I s 1 42408 <br /> 3f <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />