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Waste Tire S rev & Inspection Rei 't SURVEY REQUIRED <br /> •••��: State of California - - <br /> CIWMB183 (New 04104) Comments Form <br /> Califomia Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: I O 2 g 2 7 0 t Report I ` — 2 1 J I <br /> Number: / <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> AMVV,\ V1011S CA=S t-1 V" -t 4 <br /> � d <br /> Ck-Val•.skS • <br /> r2 v c�t� • <br /> - <br /> - Y-4CA1r. cam.�l t,t.3s �- lAr�a�► SaA <br /> C lot- <br /> Ay <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />