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Waste Tire S_ ✓ey & Inspection Rer SURVEY REQUIRED <br /> State of California <br /> •••'�• <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: "I L U O 1 Report Z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> t _ <br /> CPr c)c�_v o i1:c1P <br /> R V'\ <br /> PC <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />