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Waste Tire S, vey & Inspection Ret 1SURVEY REQUIREDI <br /> •_��-!• State of California - <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 3 C 7 - o l Report = - L D <br /> Number: l t —` <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> f C'r, <br /> >>rte- -- <, Si J <br /> �^ SS <br /> Q - - - <br /> c. � 11- <br /> r � <br /> N-�rd n J-0 i.r-)A, <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA copy <br />