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-- eY & Inspection R <br /> SURVEY REQUIRED Waste Tire <br /> _ .._ Stateof California C o-m m e n is Form <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile .s Inspection Details <br /> TPID- Inspection {— <br /> �_ J u' Report <br /> Site Suffix: ( G <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Gornments <br /> -a <br /> 1141 , 1(Ile XIA Mjp�' �Jej 111Z n3 <br /> 42408 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />