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=:::Waste Tire S�_ ✓ey & Inspection Reit SURVEY REQUIRED <br /> •!!'_±! State California <br /> CEomments Form <br /> -- - <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> ; Com, t _ Inspection <br /> TPID- <br /> l/�(1 , { Report <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Iyotos <br /> I [g I � � �l I JL5- rQSU <br /> IEXIA LIE 111251 5 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />