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Waste Tire 5 ey & InspecUon F—,% <br />3:? State of California <br />CIWMB183 (New 04/04) Comments Form <br />California Integrated Waste Management Board <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID - ` C r� / C ® Inspection <br />Site Suffix: ` J ( (P J Report = — � c� <br />Site <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />FiUI7 <br />3, 'UU ( e (EbTj LA' <br />U <br />o oh <br />1EXIAMIPILIE1rjll <br />■ White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />