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_ Waste Tire SVvey & Inspection Re t SURVEY REQUIRED <br /> State of California <br /> CIWMI3183 (New 04104) 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 /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> plc iC. ,� f- �_r,' f�r �.�_ i iAr-,;, rt_Qte�iw �:� �f K•F,/C t <br /> 42408 <br /> ■ FE ?C PlM RILE1 , 2_ 3 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> I <br />