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Waste Tire y & Inspection I�i <br /> ® SURVEY REQUIRED <br /> ■■■• ■■ C"1WMate fCalif(New O meats Form <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: ` ( _ e Report <br /> f Number: j <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments _ <br /> 12 <br /> f/ f <br /> 1 � <br /> i <br /> i <br /> I <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />