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08184040103 <br /> C➢➢a <br /> Waste Tire Survey & Inspection Report Inspection Report Number ■ <br /> ➢➢ <br /> State MB18California <br /> Survey Form - Page 1 1 3 - 10 7 0 2 8 3 <br /> CIWMB 181(New Od/Od) <br /> California Integrated Waste Management Board <br /> Part A-Surve BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- r Inspection Type (Fill one) <br /> Site Suffix:. / ( V Q Routine Q Reinspection Q Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other. <br /> Business oor Facility Name Inspected By Inspector <br /> Physical Address d 't a �e ^ 13 9 - FITO I -"- +-I Wi i <br /> 50 5kcnzoW <br /> street <br /> Inspection Date _F <br /> I <br /> STDc6rC_A 9S?l�S__ <br /> City — State Z]P Co Time In Time Out <br /> Business Rep Title Q AM Q AM <br /> tL_QI'N O 4A .---�LOWyLE�- ---____-' m m O PM m m O PM <br /> _ <br />