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Waste Tire Svey & Inspection Rert SURVEY REQUIRED <br /> •••:'• <br /> —_ State of California --- <br /> __ -----_....-- <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN_ <br /> Business Profile Inspection Details <br /> �j <br /> Inspection <br /> Q _ -7Ste Suffix : l J � `J Ll D O 1 Number: -7 -7 `'— <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> h r ayi (.,e tom• . _ /2t ym#, <br /> tW /Yt Sa —h Ci'I / a. /rl �lil ► Yt� cJYyl �t <br /> un <br /> 42408 <br /> E XIA MIPI LJEJ I 1Z3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />