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SURVEY REQUIRED <br /> Waste Tire Sur y & Inspection RepC <br /> • State of California <br /> U -- -- - - <br /> CIWMB183 (New04/04) Comments Form <br /> ^alifornia Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID- Report <br /> Site Suffix: \ v � l7 � � b \ Number: <br /> Inspection Number on the associa,ed Survey form(Page 1) <br /> Comments <br /> LV <br /> Co <br /> CLA ,,� C V Vo" t 1ti U u t:c_.c_ L jJ2 ro L, <br /> — - - -- - � - 42408 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />