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Waste Tire -Vvey & Inspection Reort SURVEY REQUIRED <br /> • �• State of California -- <br /> Comments Form <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile ;, Inspection Details <br /> _ J6 . <br /> TPID- <br /> Inspection <br /> Site Sufflx Report I — _7II i <br /> Number. 99 fff ddd III <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1 i + <br /> I i' { .-.\<,4 i_/4 ...�.,{ y'l { r <br /> r <br /> r <br /> F' tl d.i m ) , C( 1, f Y ! <br /> 42408 �. <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />