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1 <br /> :;Waste Tire S Bey & Inspection Rei t SURVEY REQUIRED ■ <br /> ■ ■__��� stateofCaliforma - <br /> CIWMB 183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> �! / ? Inspection ' _ ( <br /> Ste Suffix: I 3 -57 7 `{ �'� �j RepI ort —Z Cf j L <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> rW <br /> 42408 <br /> ?C AMPL 2 3 <br /> • White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA © ■ <br />