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Waste Tire ScArvey & Inspection Re*t SURVEY REQUIRED <br /> State• •�• CIWM fCalif(New Comments Form <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN_ _ <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> ` V I <br /> Site Suffix: � ('� Report <br /> v Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> U io iG <br /> C 'IA 3On IA,4 <br /> r , <br /> �LS lj ►L�lr1_ �l v I r <br /> 1 <br /> --t6 01 <br /> 1 � v 11 c <br /> �►i f Zvi- - - vI' <br /> S , <br /> hxi.!H� <br /> (Jl Iv UJ <br /> 42408 <br /> JE XIA MIPILIel 111a n3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />