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Waste Tireey & Inspection R SURVEY REQUIRED <br /> State of California <br /> CIWMB183 (New 04/04) ®rnr�ents Form <br /> CallfomiaIntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile inspection Details <br /> TPID- Inspection <br /> 1 p m Report I 0 <br /> Site Suffix: ` -1 Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> � �►�"►GS`' I: 1 _ (Pit JS Gam, ✓W�G - - <br /> Tfu <br /> �-t'sl5at��3�- 01 . J - <br /> 6 asP- <br /> Vit k, CkA tllj� <br /> ■ <br /> � � 42408 P L E III ?-T3 � ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />