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:Waste Tire rve & Ins ection Re �t <br /> y p p SURVEY REQUIRED <br /> ■•■'•: State of California <br /> CIWMB103 <br /> New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: Report I — <br /> O Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> l�fQ <br /> cLo S C_ <br /> -�/V <br /> IEXIAMIPILIE! 1 1 2 3 42408 <br /> r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />