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Waste Tire S vey & Inspection ReArt ° ARA,EY REQUIRED <br /> •••�� State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> ILA <br /> FS41% <br /> Report <br /> InspectionSte Suffix: 3� 19 1 O 1 Number: I IO U 1 3 �\p <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Viil <br /> f e. c r_s, <br /> uc�i� —ate—�u`iouV <br /> ?C A IAh PL T 2 3 42408 <br /> I <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />