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Waste Tire S&ey & Inspection Rer t SURVEY REQUIRED <br /> ••"�• State of California <br /> �— CIWMB183 <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 I _ I ' 9 <br /> Site Suffix: ' S S 1 S Z , Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> s-JE o� <br /> 42408 <br /> A PSSeI 1123 <br /> r �White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />