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Waste Tire SArey & Inspection Rept SURVEY REQUIRED <br /> ■ o■a.r■ StateofCalifornia ■ <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- Q inspection <br /> Site Suffix: ' 4 �j Report <br /> Number: L� <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> • ��.�� �;�-�-5 rev.v�c b_�. - �2 C.,�-��- -�c-o w--,- <br /> V - <br /> � ay c.� -F�G lrJ� � C� 9� �� �e P C� �ir►�P T d <br /> JE XIA MIPILIE1 11112131 42408 <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA a i E <br />