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■ : State of California <br /> :::_ SURVEY REQUIRED <br /> r._.�.Waste Tire S ve & Ins ection e � �___ <br /> CIWM6183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- L r Inspection <br /> Site Suffix: (� (� I Report = — 3 <br /> v ` Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Sc. rn CA CAA1601� <br /> Ie <br /> a F����� �Sty� �� • �JoautA5 -11-o ` move, <br /> Ilk <br /> 42408 <br /> E A PLE i 23 <br /> w� <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />