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_ Waste Tire SL Y . & inspection Rep <br /> SURVEY REQUIRED <br /> State of.California <br /> 0-1 <br /> luB183 (New <br /> w00Comments Form <br /> Cali Integrated 04104) Comments - . <br /> r BLUE OR BLACK INK PEN <br /> Business Profile ! Inspection Details <br /> TPID- - Inspection <br /> Site Suffix: Report <br /> I i <br /> Re f I t <br /> � Number: <br /> Inspection Number on the associated Survey form(Page ) <br /> Comments <br /> e <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />