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Waste Tire S . vey & Inspection Re� .-t SURVEY REQUIRED <br /> 6"928 <br /> •'•• State ofCalifornia---- Comments Form --- - ----- ------- -- <br /> CIWh7B 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> I <br /> TPID- /l - Q Inspection I — r7 <br /> � V <br /> Report Site SSuffix: Report Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ali <br /> - t <br /> tA <br /> Ica (-h coo cern <br /> P <br /> -Of (( V,CW_ - - - - <br /> 1 <br /> 42408 <br /> E X A M P I L I El 111 2n3 v <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />