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=Waste Tire & Inspection Ret SURVEY REQUIRED <br /> ■■■_+•■ State of California <br /> CIWMB183 (New 04104) *tnts Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 �j v 01 Report �l Q ? �J <br /> t Number: C� <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> All LaAE.tas �._ <br /> -man YOCIQLA10 CIOIAD , -Efb- <br /> 6�3- A3�2- - - <br /> M nom__Wosie -},re rn a%�es�s -- - <br /> n J CAJYIIA No or are (31 C-anc e.r n. <br /> Nu � ase -fion J I A)6R.n -t-rn yar4e&- <br /> �n quanAies 10- or wore ,m LaN-,,,en 71--rs�ol_ <br /> -�r—e-g+ o ref <br /> 10/02/ <br /> CIL <br /> 42408 <br /> E-XA Mt P i I� E111273 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA LOOT <br />