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Waste Tire S,. #/ey & Inspection Rer, t SURVEY REQUIRED <br /> •••'•• State of California <br /> -" CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` / Inspection <br /> Site Suffix: 1 1p 3 O 1 Report $ u <br /> Number: 1 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> L, r A <br /> oli( es---6inu_.e. +V-�.Ll-ti�b� IRS <br /> I)J- C'W � <br /> 42408 <br /> jEXjAMjPj �JEJ 111213 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />