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uWasts ire <br />= <br />r�'� a State of California <br />• CIWMB 183 (New 04104) <br />California Integrated Waste Management Board <br />SL iey & InspecUon Rep <br />Comments Form <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />Business Profile <br />TPID - <br />Site Suffix: / b s O <br />Comments <br />�p �j ® <br />Inspection Details <br />Inspection <br />Report = ` — t q Z S 6 <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />XIAMPLl; 11!a73 <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />