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Waste Tire Wey & Inspection Re jert 09 1 <br /> SURVEY REQUIRED <br /> •••iSr StateofCalifomia <br /> CIWMB183 (New04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> I <br /> TPID- Inspection <br /> Site Suffix: Number: 1 I Report I — 1 0 ^4L&1=0 � <br /> J <br /> --LL-- <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 42408 <br /> j1EjXjAjMjPj0EJ 1112 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />