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_ 4IWaste Tire SWey & inspection Rept SURVEY REQUIRED <br /> ••••�! State of California <br /> CIWM— -- (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - M _ Inspection <br /> Site _ <br /> Site Suffix: � v ` Report I � � 7 <br /> I Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> / 7 <br /> a 'rel <br /> 3_ N <> <br /> le A MIPILIel 1112T3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />