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■ 1;;.;--I, Waste Tire S.. -3y & Inspection Rep SURVEY REQUIRED <br /> Gni.,. Stateof California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: j 11 - Report I - !� U , 7 <br /> ` o <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> V;o i 'ar�s a r <br /> ,rtmava� — <br /> ' XC A MIPIME1111273 42405 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />