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Waste Tire SL*ey & Inspection Repot ' gURVEY REQUIRED <br /> ter•_ Comments State of California C F0"111{y� <br /> CIWMB183 (New 04104) <br /> U!-i W <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile-- <br /> Inspection - - <br /> Details <br /> TPI <br /> Site Al—k-A <br /> _,_, _ Inspection <br /> Site Suffix: <,_ 4.- ! _, � ' - Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> - - - - <br /> Comments <br /> Jr- <br /> C <br /> `> <br /> � 42408 <br /> ■ �t P L <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />