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Waste Tire S le & Ins Inspection Refit <br /> Y p SURVEY REQUIRED <br /> •:�� State of California <br /> CIWMB 183 (New 04104) <br /> Comments Form -- - <br /> -- <br /> CalifornialntegratedWasteManagementBoard BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - + s ® Inspection _ <br /> I Report I 72- 4 Z <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1QS lvot--5 <br /> ; r r a4 52 IN I7 W 5 <br /> Ca <br /> Gtr cLjCCc S <br /> \ T <br /> t .. ` 1l� 6Y\ <br /> v -(a r <br /> CL <br /> 1 <br /> tv— <br /> ca <br /> JE <br /> 42408 <br /> 7f A P (r 1 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />