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t;-.:qWaste Tire S_ . vey & Inspection Ret I SURVEY REQUIRED <br /> hi. '•'• State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR_BLACK <br /> IN__K PEN <br /> Business Profile Inspection Details <br /> TPID- Q Inspection <br /> Site Suffix: / o l � ! Report / /�j `� <br /> 6 `/ ( Number: L. L ✓ (�j <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> All+ <br /> ,fes J)IA ( I C30 A 7'o&- / n ll� 7 <br /> A f l_�7 -n-F-)-) i,,yc re dulls I r— A_1 i P <br /> �x <br /> IE XIA MIDI LIEI 1112131 424081 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />