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Waste Tire .vey & Inspection Re, rt i SURVEY REQUIRED <br /> ••••�• State of California <br /> ---- Comments Form - - - -- --- -- <br /> CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> ur� Inspection j 5 <br /> ` LA a, 0 1 V I Report Number: <br /> Site -Suffix: LA 0 f�V / <br /> Site <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> u� <br /> uV-r u,T 1'j o rn �uJ'f 0n1 <br /> J <br /> C.I t t i GI j_ <br /> �� 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />