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Waste Tire Su. ,rey & Inspection Repc. 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 a <br /> I s / � � / � Report <br /> Site Suffix: 2 t — •l Z � � Z 5 I <br /> Number: P <br /> Inspection Number on the associated Survey form(Page 7) <br /> Comments <br /> rt <br /> 3. Re-�r,\." <br /> qLIEI 111273 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />