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---------------- <br /> Waste Tire S ►ey & Inspection RepietSURVEY REQUIRED <br /> ••"'• StateofCalifornia <br /> CIWMB183 (New04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 �} Inspection a q <br /> Site Suffix: 1 6 5 q V 1 ReportZ - <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> - C ccs c� �\ 1,� a.\-P rS Ao <br /> 42408 <br /> I XIAMIPILIEI 1 , 1zT3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />