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Waste Tire S. <br /> ey & Inspection Rep^Yt SURVEY REQUIRED <br /> ■ .'��_`�_`_• State of California ---------- —I <br /> CIWMB 183 (New 04104) Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 y 3 l Report = l — l / <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> -- Mok f r <br /> 2- ) A)a 4 rc - 7jrzc.E <br /> -3- �U0 SfVr-rcd 0-ki s�'/r . <br /> v►•,y.,�,1 4-0 �✓1 C�� 4t�l��c� %ice) � )�( � i��J z - ®1EXIAMIPILIE1 111273 ( <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA LeT <br />