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;izWaste Tire S. rey & Inspection Re <br /> pt►t SURVEY REQUIRED <br /> State of California __—_—.__� <br /> C11 MB 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: 1 Q z -7 8 S d 1 Report j - l ? 7 ' 6 'Z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> pokes, <br /> . <br /> ?.) ct L- - Se-uo-cL. C�o � <br /> �V-O vM, - <br /> C', <br /> k a �k <br /> - <br /> Xeo��S <br /> 42408 <br /> JE A MIPILIel 1 ; 2 3 F:M]M " <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />