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- Waste Tire s` .e & Inspection Re <br /> --- Y p p SURVEY REQUIRED <br /> State of California <br /> --- Comments Form __ - - _ <br /> � CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: I �j $ 6 y Report I r 2- 9 s Z � S <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ax <br /> 4�sR- <br /> �S S�tc �•�S <br /> C3��- '��.Loco- `c�✓� . <br /> 42408 <br /> JE XIA MIPILIE1 11 131 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />