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' 1 <br /> Waste Tire S re & Inspection Re 'tSURVEY <br /> t EQUI <br /> Y p � SURVEY REQUIRED <br /> •••��' State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> "usiness Profile Inspection Details <br /> 'ID- Inspection <br /> bite Suffix: Ip 3/ - Report Z / Number: 1 7 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Mao <br /> a ei S Sr 7 ,4c4e z f a —)►J''zz r arL4 ' f Lt�lir <br /> CJY1 L'L� <br /> s�gcdclv� i p/D � �- /�! 3S-6 z —o/ <br /> ID X A MIPILIE1 111273 42408 <br /> I <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />