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::_:Waste Tire Sevey & Inspection Rer t SURVEY REQUIRED <br /> •'��! State of California <br /> CIWMB183 <br /> New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 <br /> Inspection <br /> a u <br /> Site Suffix: 1 3 / 5 2 Z 1 Report I l — ' Z L. 1 1 I <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> C-S i v �� c�-�'s� C�c e lo`•��i <br /> v� d-\A <br /> Ce �� , wr\% k,,. <br /> le <br /> XIAMIPILIel 1112T31 <br /> 42408r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />