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Waste Tire St rey & Inspection Rept SURVEY REQUIRED <br /> ••�-• State of California <br /> New 04104) Comments Form <br /> CIWMB 783 ( <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection 1 q <br /> Site Suffix: 1 2 ® l Report <br /> Number: VV <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> (�"•S C�Y�_� �V c��� o��jl l� �aC *C��9:2� � 7� <br /> JE <br /> _ 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />