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- Waste Tire SLey & Inspection Reple 1 SURVEY REQUIRED <br /> State of California <br /> ka <br /> — <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> i !-� Q S r? 0 0 Inspection <br /> Site Suffix: _ <br /> Site Sux: I I �vC, Report I � � � '7 Q_ 5 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1� G S <br /> VIM' G <br /> lP&DIalu—nitoo 0 -to t <br /> JE XJAMJPJ �Jel 11 2�131 <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />