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=_ Waste Tire S- rey & Inspection Rer t <br /> SURVEY REQUIRED !'' <br /> State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 m Inspection _ L C <br /> Site Suffix: <br /> 1 1 V ` Report = '1 I 1 0) 6 ✓ S <br /> Number: <br /> Inspection/Number on the associated Survey form(Page 1) <br /> Comments <br /> �4� <br /> V <br /> �2�►y�®� �c Cid.;�C;�. �—_ ��C� <br /> IEXIAMIPILIEI 111273 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />