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:= Waste Tire4Wey & Inspection R*&t SURVEY REQUIRED <br /> ■■■+•: State of California <br /> CIWMB183 (New 04/04) mments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile _ Inspection Details <br /> TPID- —. _. - " In ort <br /> � I y � Inspection _ (� J �T8 Site Suffix: s ��� --j � ��' 1 I Number. `''. ; �I <br /> ! Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 3c—VAGA ckt -()ns Or -Qr ran- -Pd <br /> JE A M Irl 41�I�1111273 <br /> 12 3 42408 <br /> � <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />