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Waste Tire v,Arvey & Inspection Re, -)rt <br /> � SURVEY REQUIRED j <br /> State of California <br /> - - <br /> L2CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board _ BLUE OR BLACK INK PEN <br /> siness Profile Inspection Details <br /> Inspection <br /> PID- "� p I �j 3 7 J <br /> Site Suffix: t ;� i � 1 � L V � Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments — <br /> - <br /> !�_ - J <br /> t �l'1 �lilst t�1 t' <br /> ► 116A) <br /> A. <br /> (� Ct3me 5► �1 e IYYYt <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />