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i <br /> Waste Tire S�ey & Inspection Re SURVEY REQUIRED <br /> +�■ State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- .I Inspection <br /> p Q <br /> Site Suffix: �rj Z Q )T 5Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> er2 avws. A <br /> GrCcu C _vnncipf n - - - <br /> p m 1 CA 2r ed -rj Y P S yv LA _ 1 �Tt�C� �r.)hwr. . inr a rs`�- <br /> in 9" C.. C} l0 or more of I 6n -7Y & i <br /> +ton _ <br /> 42408 <br /> EXAMF L E 1 2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />