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a <br /> Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> State o (New <br /> Comments Form <br /> CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> •siness Profile Inspection Details <br /> ID- Inspection <br /> site Suffix: 1 - C) Report = r _ [! Q i. <br /> Number: i 7 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> —cK _T t12'r�,�t � Cm fi xe-, - Bc 4 47 0,4 - <br /> 42408 <br /> t: XIA MIP L Ej 1iZ 3 <br /> :MT <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />