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Waste Tire S Bey & Inspection Rep t SURVEY REQUIRED ■ <br /> ■ ..._. <br /> �•"'� State of California <br /> CIWMB 183 (New 04/04) <br /> Comments Form - --- - _ _ <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> t Inspection <br /> TPID- T 1 r a <br /> Report <br /> Site Suffix: <br /> l 1 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> JE XIA MIPILIE1 It 12731 <br /> 42408 <br /> ■ White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />