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nia <br /> W.111121 <br /> _Waste Tire SO & Inspection Rei SURVEY REQUIRED <br /> !•. State CIWM f183((New <br /> Comments Form <br /> CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- c� + Inspection <br /> Li SO <br /> Site Suffix: ` J 3 l0 1 Report I — a O <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Oc,S', �- erne,+>> j vv '�v�`IZISeJ'v� tae, <br /> �l_c �� �'�r✓ cf'v� t� . r�UVur�'s v 3 sunnv� <br /> �l0 Arte, Scr•ti tic, lls m& ncr 4Wl4ts <br /> dl t►-0 +S. S�L5 , <br /> Ws 15 k IA-kS ) <br /> ISOJQIC—y� <br /> f-L4 ukilkraw (1119-awdx- <br /> c.,JC,+Wl rw6 C-, <br /> i cW S y <br /> L -�v `' vL 1 Jc,-) <br /> s ( j6i-) S,Te, <br /> "A <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />