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® ;- Waste Tire trey & Inspection Reqft sURVEY REQUIRED <br /> ■■■±�■ Stateof 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- ii /� �y Inspection Suffix: 1 �...ti- V S 6 .�' i .� Report <br /> Site SuI i I lJ v <br /> ._ _ - Number: Q 6 0 1 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Qa�lPJ! ^V <br /> _ 1— 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />