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Waste Tire ve & Ins ection Re t <br /> y p SURVEY REQUIRED <br /> ••:+^„• State of California <br /> CIWMB183INew04104) mments Form <br /> California Integrated Waste Management Board_ _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- rr Inspection <br /> Site Suffix: Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> No o u I CG tr c—,,4'�c Y\S 0-y- O ,4P <br /> 3 Q . <br /> '-p�fCL j- moa <br /> 36 2 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />