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;__Waste Tire S�rey & Inspection Rept SURVEY REQUIRED <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 /> TPIInspection _ <br /> Site - i ^ r] 7 .7 Report I <br /> Site Suffix: l / / Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> IV <br /> >CLS�ro� <br /> Zoc fc qk t co <br /> v"', t �� wens �� Q! : o 5 0.5 d� <br /> v c, �%r, <br /> 2V -all <br /> C <br /> IEXIAMIPILIEI 1112131 42408 1 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />