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Waste Tire S vey & Inspection Rep `t SURVEY REQUIRED <br /> ■ <br /> ■ ... State of California --- ------- --- <br /> CIWMB 183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- I ` Inspection <br /> Site Suffix: S - t Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - <br /> f� 1' 15 cti ,'S- c; ,,tt,„_ c —n -ter <br /> J1, MIA 11 <br /> 42408 <br /> • White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />