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Waste Tire Sly & inspection Repo* 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 /> TPID- Inspection <br /> L 1 Inspection <br /> Site Suffix: 1� c-7 5 ' V C ` Report I l — I 2- 1 J l7 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2� Leer-: <br /> <r <br /> 6 f r <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />