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6�- --A <br />c��ass- <br />�e7,sk— <br />�i <br />XIAMIPILIEI III <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />':::;Waste Tire <br />State of California <br />SL fey & Inspection <br />RepsSURVEY <br />REQUIRED <br />C_- <br />CIWMB183 (New 04/04) <br />Comments Form <br />California Integrated Waste Management Board <br />BLUE OR BLACK INK PEN <br />Businessi Profile <br />Inspection Details <br />Site - <br />Site Suffix: <br />_ <br />� <br />Inspection <br />Report <br />_ <br />Number: <br />VVV <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />6�- --A <br />c��ass- <br />�e7,sk— <br />�i <br />XIAMIPILIEI III <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />