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:=. Waste Tire SL /ey & Inspection Rept SURVEY REQUIRED <br /> ••°s! State of California <br /> Iii CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> 1 = a <br /> TPID- tion <br /> � � '-2 � � � � � Report Inspe <br /> ort 2 <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> '71 D, <br /> j• —,1G W-G� piesi l�S c s v4 <br /> c `cqAA Q <br /> IEXIA g 111273 42408 <br /> 11 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />