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Waste Tire S*ey & Inspection ReK _t SURVEY REQUIRED <br /> •••�•: State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- z _ Inspection <br /> Site Suffix: ✓ Z S — d Report I 1 — I Z S -5 G1� <br /> Number: / <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �Jc3�e O <br /> qlo- <br /> `f .ter, uL"IX. A- U4UJ <br /> 414 ikki atla.c'lachb—, ,fir y ey`144-j . <br /> tri <br /> JE XIAMIPILIEI It ! 273 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />