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:::: Waste Tire S rey & Inspection Rer t SURVEY REQUIRED <br /> ••"" State of California <br /> CIWMB183INew04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: I - 5 C> 3 Report I 1 — 1 2 2 d 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> n <br /> k <br /> .0 <br /> 14 <br /> Aj o C.,A <br /> �s <br /> AAA a �_ <br /> 42408 <br /> � ?� � JJI �' I� � 111273 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />