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:., Waste Tire A ;y & Inspection R& SURVEY REQUIRED] ■ <br /> ■••'�-r'_ 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- Inspection <br /> Site Suffix: 5 l Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> No °- �• (,11� Clle1 UJ�e�a-- x,5'1 �(�S �i V.� �'�'� <br /> of cky� anA �fi): 0 <br /> 1 <br /> n1.(A,(1a 'A UQZIS 064A M41 <br /> J- n c,�ion- <br /> JE <br /> A MJPJJEJI- 42408 <br /> ■ <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />