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U.3 <br /> Waste ,Tire S, ,ley & . Inspection Rer -t 150RVEY REQUIRED <br /> •'■L' State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN . <br /> Business Profile �Inspection Details <br /> TPID- u ction ' 1 <br /> Site Suffix: , \ I g O 1 O 1 Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> � kjw - --0j A'N <br /> jEjjXjAjjMjPjLjEj 1 2 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />