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■ ._ Waste T'v S Bey & Inspectio V'.er L SURVEY REQUIRED <br /> ' 1."fix State of California <br /> .. <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- Inspection C. <br /> Site Suffix: (G z ) `1 �� Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - — - - - - - -- <br /> 4121 <br /> �Jsyds�Su11 -- <br /> r�- <br /> 571 Xe- 3x f <br /> Ole <br /> A MIPI LJEJ 1 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />