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*: Waste Tire Sl ✓ey & Inspection Rep t SURVEY REQUIRED <br /> ••• State of California <br /> CIWMB 183 (New 04/04) <br /> Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site Suffix: r � "I Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ce <br /> CS <br /> le XIA MjPjLjEj 1112T31 <br /> 42408 <br /> s <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />