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N?b <br /> Waste Tire fvey & Inspection R -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- ° Inspection <br /> Site Suffix: Report — <br /> i Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - - <br /> lk <br /> i <br /> t i <br /> ; 1 <br /> le �y IA ++�+1 P I—E 2] 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />