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waste Tire S- ay & Inspection Rer SURVEY REQUIRED <br /> ■_•_•�•■ State of California <br /> CIWM6183 (New 04104) OmmentS Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> --- ------ -- -.. ---- - ---- <br /> Business Profile Inspection Details <br /> — -- -. - -- -... --- - -- <br /> TPID- Inspection <br /> Site Suffix: F - Report I - <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - <br /> 42408 <br /> Ey A MI I� E 2 3 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />