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Waste Tire S & Inspection Re A <br /> vey ns pecI- SURVEY REQUIRED <br /> iii+_i■ State of California <br /> a CIWMB 183 (New 04104) <br /> Comments Form ------------ - <br /> Ku - ----- <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - ® Inspection _ I 3 <br /> Site - °� Report = 1 <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> lzjS1,n Cz. <br /> -� ` <br /> -Alm A4ie.c S. <br /> 1fos" <br /> N99 OJ <br /> G � <br /> Air a <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />