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:Waste Tire 5 rvey & Inspection <br />State of California <br />ClWMB 183 (New 04/04) Comments Form <br />ment Board <br />BLUE OR BLACK INK PEN <br />California integrated Waste anage <br />Business Profile <br />to*t <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />California integrated Waste anage <br />Business Profile <br />Inspection Details <br />TPID - <br />C <br />Site Suffix: 0 <br />Inspection <br />Report -7 4-1 7 0 <br />Number: (Page <br />Survey <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />1�r/rM 1-2 <br />a-lq-11 Pesu AHS <br />42408 <br />EXAM iL E 1 2 <br />■ White Copy: ClWMB Yellow Copy: operator Pink Copy. LEA <br />