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Waste Tire S_ ✓ey & Inspection Reim SURVEY REQUIRED <br /> ••"�• State of California <br /> CIWMB183 (New 04104) <br /> Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Tl ¢ Inspection <br /> PID- I 7 1 tJ _ �� j Report 2 1 — 1 G.. <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1 c5 2 <br /> to I2q O<J ✓v Ste-c"-1 <br /> T <br /> by-5 t 2 hct <br /> VL'Y <br /> Zr'i2 t1 u i2� c tom-. <br /> GCyc�u, <br /> La t;Lt� A ► et,,-v <br /> -41 �aCce �f„v, <br /> 42408 <br /> JE A MIDILIEI 1112N r=_7 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA r� 1 <br />