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VAWaste Tire St Bey & Inspection ReAh SURVEY REQUIRED <br /> :::;L <br /> __�_. <br /> State of California <br /> W - --- <br /> zy CIWMB 183 (New 04104) <br /> Comments Form - - - <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID- �r' n <br /> Site Suffix: �") O t j j,/ - ,r, Report <br /> i Number: L LJ CJ <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> A)c VnJaz6vns or zkl-ze- s r l L� ri r rbc <br /> c t� ✓ <br /> J <br /> 42408 <br /> M� <br /> A E �2 li <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />