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Waste Tire S6 Bey & Inspection Rep SURVEY REQUIRED <br /> •'•�� State of California <br /> ^" CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- - Inspection <br /> Site Suffix: 3 7 6 ;1- -.7 - Cj ' Report I � - f ) 2 � � -7 (a <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ?/»r <br /> An Ike I aze r k <br /> X A P LI I 2 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />