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SURVEY REQUIRED <br /> . Wastes Tire Sla. .ey & Inspection ReptState of Californi <br /> CIWMB 183 (New 04104) <br /> Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> I <br /> Inspection <br /> TPID- �l L l n Report I — 6 t <br /> Site Suffix: v Number: <br /> Inspection Number on the associated Survey form(Page 1 <br /> Comments – — <br /> q - <br /> A I t <br /> 7-3 —EITTS ICA <br /> •-Iy,-s <br /> 42408 <br /> EXAMIPLE 1 2 3 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />