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Waste Tire St Bey & Inspection Rep�'-t SURVEY REQUIRED <br /> '••"! State of California <br /> CIWM8183 <br /> (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` Q / l� Inspection <br /> Site Suffix: 1 -1 rj 1 5 1 Report I I - ` q 6 Z g 6 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> JE <br /> �'1ri�`ot��•C� <br /> }4 A MIPI Ljej 1 I 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />