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Waste Tire S vey & Inspection Rer 't SURVEY REQUIRED <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- L Inspection <br /> Site Suffix: ` S $ 2 p Q 1 Report I 1 — 2- <br /> Number:Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2.). <br /> As��2 <br /> ate& ��S <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />