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Waste Tire SudOev & Inspection RepSURVEY REQUIRED <br /> ••'�•` State ofCalifomia <br /> T CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- <br /> '37O 7 D Report <br /> 2 n <br /> 1` S InspectionL� - � <br /> Re ort <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2. <br /> 6 V\ -I;C� om �M <br /> e r <br /> �� `^'Cv�►-� �f-� C <br /> Yds <br /> 7. <br /> -� �o <br /> 42408 <br /> Ir XjAMjPjLj1Ej_ 11273 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />