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LZ <br /> _Waste Tire SL ✓ey & Inspection Rep t SURVEY REQUIRE <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- - Inspection _ 3 -75- <br /> ® <br /> Site Suffix: ` � t � � Report I <br /> ` Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> A <br /> re. a k <br /> n r <br /> +bn �Z, vy <br /> A P I E 1 1 1 42408 <br /> ' � ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />