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■ Eo=., <br /> Waste Tire ey & Inspection Re tSURVEY REQUIRED <br /> �raY� � State of California <br /> CIWMB183 (New 04/04) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> TPID- Inspection <br /> �1 - m Report m <br /> Site Suffix: ,j <br /> Number: } <br /> Inspection Number on the associated Survey form(Page 1) <br /> - Ck <br /> L I <br /> Oy ,11��, x_.1,: -1\A <br /> &ulz` M(.1��,� C� \CSL ��5 ttiL`� �Y\ti� wiz- <br /> �A ku W,c ka <br /> E,iX��L�� 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> I <br />