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Waste Tire SuOey & Inspection Rep FSU7RVEY <br /> •••'�: State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection _ 9 <br /> � � <br /> TPID- 1 / � � _ � Report I Q <br /> Site Suffix: u � 0 Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> C>A V�. S G a_ ;a V\ . <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />