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;k <br /> :Waste Tire Soey & Inspection Rep* SURVEY REQUIRED <br /> !!�•` State of California �— REQUIRED] <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - 1 ` �+� Inspection <br /> Site Suffix: _1 Report I 2 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> e -5 7 <br /> �- e- �.c c\•�- <br /> S <br /> 26 7h6 <br /> 5 .�� <br /> 42408 <br /> JE XIA MJPJ � a i1 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />