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® ,:_'Waste Tire S --. y & Inspection RepoSURVEY REQUIRED'' <br /> State of California - --_.. <br /> it CIWMB183 (New 04/04) mments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> ------------ <br /> Business Profile Inspection Details <br /> TPID- Inspection r <br /> Site Suffix: _ Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> r <br /> -- --�- — - <br /> l� <br /> I <br /> 42408 <br /> ■ � X A X11 P1; L 111273 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />