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Waste Tire Sl ;y & Inspection Repdo SURVEY REQUIRED <br /> •'•• State of California <br /> LNUI <br /> �_------------ <br /> CIWM6183 (New 04104) Comments Form <br /> California Integrated Waste Management Board _ BLUE OR BLACK INK PEN <br /> �tusiness Profile Inspection Details - <br /> - _ Inspection <br /> Site Suffix: a Report I /1 I-zj 3 y Q <br /> i Number: ,j-- C L <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - <br /> f9r, <br /> PS4- r7-PTn 6/111-130' <br /> �� 1 r <br /> {- o4, --hcz� lets ! fir{ +I <br /> ctt,��e- -�V <br /> ol. Twee Llvnc.xt a. ►��5 <br /> ILIan4LY 0 16 i-nis - <br /> I�t�� <br /> 42408 <br /> s <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />