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Waste Tire urvey & Inspection r fort uRVEY REQUIRED] <br /> State of California <br /> CIWMB183 (Now 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID Inspection <br /> / 3 /l '� ` e C,f i Report <br /> Site Suffix: 111 "( G.x Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> l <br /> 4k, kbzly <br /> D /1) S r 12 Z fn <br /> T-7 112- <br /> Aj- l� dyGr P.Z�c-(.�� ,�- e u �w ' -3 ,Lc,'s <br /> 14•) Ll lio �-afw w GaL <br /> 42408 <br /> EnXIAMPLE �' �" 3 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />