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Lo1Waste Tire s�ey & Inspection Rep SURVEY REQUIRED <br /> State of California <br /> CIWMB 183 (New 04/04) <br /> Comments Form -- --- ---- <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- r Inspection <br /> Site Suffix: 0 y Z ('J / Report <br /> Number: T 7 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> - i If r- JJaemurvct-j�1- <br /> 1EXIAMIPILIE1 1 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />