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Waste Tire S vey & Inspection Rer 't SURVEY REQUIRED <br /> State•�-• CIWM fCalif(New Comments Form <br /> CIWM6133 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - ` t , O - Inspection <br /> Site o 7 o ' _ q � 5 <br /> Site Suffix: "1 Report I g <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> CX>Naf= e_ c14-A- c, c��e Ao NKk�� <br /> 3 ���,� w, caw• <br /> JE XIA MJPJ �JEJ 111273 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />