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:Waste Tire ey & Inspection Ret SURVEY REQUIRED <br /> ■■■+•• State of California <br /> (New 04/04) omments Form <br /> r CIWMB 183 <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site Suffix: f I Number: <br /> _ �- —/—��- —�f ---.-- <br /> Repor <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> JG <br /> r. <br /> _1 / <br /> - <br /> / <br /> r <br /> 42408 <br /> XAMPILE I3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />