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6:= Waste Tire SL �ey & Inspection Rep t SURVEY REQUIRED] <br /> ■�••-•: 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 /> Inspection / <br /> Site C) S ® , Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 5� 'r <br /> 42408 <br /> IF XIA MIPILIE1 1112R-3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />