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Tire S ey & Inspection Re l SURVEY REQUIRED <br /> •:lWaste <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 Report I — 1 t1 6 �^ <br /> Number: l / <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> lox 0,M&I <br /> nldk s ' <br /> - <br /> IE. IA:.AIPI �IEI 1112131 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />