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Waste Tire 90ey & Inspection Re t SURVEY REQUIRED ', ,v <br /> ® "■■..i,.. State of California ' <br /> ---__- Comments Form - <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN r <br /> Business Profile Inspection Details <br /> TPID- <br /> Inspection <br /> ,. <br /> Site Suffix: p - � <br /> _ <br /> , !! Q �\ 7`t J 7 ~ �` Number: ! C <br /> Inspection Number on the associated Survey form(Page 1) - <br /> Comments <br /> 771 z_CA t f-<', f _— <br /> 42408 <br /> [e XIA MJPJ �Jej 111213] <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />