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Waste Tire S vey & Inspection Rer ,I SURVEY REQUIRED ■ <br /> ■ ,• ■..,a State of California --- --- <br /> CIWMB183 (New04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> St Suffix: 5 t , ' 1 ® I Report <br /> ` l Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �1 C 6-01 - ' <br /> ',, <br /> ,NtS C. l n i�lc� G�`.� c,� I� c�.� L/o yyn C- <br /> S <br /> YL° or-�cJ MCC 19y <br /> 42408 <br /> 1EXIAMIPME1 111251 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />