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9 Maw- <br /> :. Waste Tire Arvey & Inspection RepIrt ° SURVEY REQUIRESatD <br /> • '== + CtIW Of t:3 (NOW Comments Form <br /> CIWMB 187 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- � Inspection [�T Site Suffix: — D Report I _ I r rNumber: L� `� J <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> a� p_Pe.s_._R�u.�s0. .fir �s <br /> ; ,s ut&t& o_cccr 4i oma l(y b vf n D� A.-f_(,urreA ` wi 9-6e <br /> elc&,k 8 -Prodi-s re-mD✓eof 15'00 Gr,-6 & Yards of Waste <br /> To'r of -Pa azlI �arc( Uric ope,�,ah <br /> ND V io 1A-C -s h oted.e <br /> Taal -� <br /> E�xIaIIMIPILIEI 112131 42408 <br /> ■ White Co :CI Yellow Copy:Operator Pink Copy LEA <br />