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Waste Tire S rey & Inspection Repot SURVEY REQUIRED <br /> State of California Comments Form <br /> e• CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details �7 <br /> 2Z 5 01 Report inspection <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �n ua, w0.Y <br /> Ir <br /> S <br /> 42408 <br /> IF A M P E 1 2131 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />