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:LESS <br /> :Waste Tire S iey & Inspection Rer t SURVEY REQUIRED <br /> State CIWM f183 California <br /> (New <br /> Comments Form <br /> CIWIr1B 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID C j Report I — 6 <br /> Site Suffix: U Fj l Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> X611 <br /> �f <br /> �, t/YtC� ✓1� c <br /> -- ------- -- <br /> 42408 <br /> _M10JOE1 I ' M <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA • <br />