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Waste Tire Survey Inspection Report�/ ti <br /> � p SURVEY REQUIRED <br /> State of California ---— <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- v Inspection _ <br /> Site Suffix: _I 601 d Report 2 1 1 2 5 C O S <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> LC C-Oc <br /> 1EXI <br /> A MP L ! 1 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />