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.. Wastes Tire St iey & Inspection Rep t SURVEY REQUIRED <br /> State of Californi <br /> ■ CIWMB183 (New04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: l , -7 3 O ` Report I 1 — 1 7 9 2 O <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> _�c'ri✓Se�c�e� vaAG <br /> osus�� °s <br /> C <br /> e XIA MPI LE) ?T- 3 42408 ii �' ■ <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />