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■ _ Waste Tire �� ;ey & Inspecfoon Rep d SURVEY REQUIRED <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: 1 <br /> ' S l O 6 I Report I ` _ ` I 9 <br /> !. 1v <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> a) c �As�lt, •'2 <br /> �s��,��. w�c����•-sem w.�� �e �ccQ� <br /> �S vias `re�5 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />