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_Waste Tire S ey & Inspection Rer SURVEY REQUIRED <br /> •••'�• State of California <br /> -" CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID- g _ Report <br /> 7 `"1 � � I — Q <br /> Site Suffix: I J Number: 1 1 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �5. d ce� <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />