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k <br /> :Waste Tire SL �ey & Inspection Rep SURVEY REQUIRED <br /> • State of California(New 04104) Comments Form <br /> CIWMB 183 <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - 1 _ 0 Inspection <br /> Site _ I 3 <br /> Site Suffix: � 1 Report I <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> \� tic zo <br /> Nll <br /> o21Y,Al <br /> , <br /> JE <br /> 42408 <br /> ? A M I} L T 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />