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Waste a Tire Sey & Inspection Rep Y <br />■ ..._ <br />State of <br />CIWMB183 <br />New 04/04) Comments Form <br />California Integrated Waste Management Board <br />SURVEY REQUIRED] ■ <br />BLUE OR BLACK INK PEN <br />Business Profile <br />TPID - <br />Site Suffix: <br />Comments <br />Tw <br />t r7 <br />� <br />\S <br />Qb <br />Inspection Details <br />Inspection <br />Report <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Cbvp Wkt--,A�4 kS QC Y", <br />VILA-Niilx& <br />t Vvw1nM2Ji/` <br />EIA MI P I L I El It1 3 <br />■ White Copy. CIWMB Yellow Copy. Operator Pink Copy. LEA <br />42408 <br />0 0 <br />