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■ : Waste Tire S. vey & Inspection Rei. .t SURVEY REQUIRED, ■ <br /> -•�:'^�_ <br /> State ofCalifornia <br /> ( <br /> CIWMB 1833Neeww 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> tsiness Profile Inspection Details <br /> 5 1 - Inspection <br /> PID- - <br /> Site Suffix: t q `� f� Report I� 1 Number: <br /> LA <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> a• ri�Q-1 , flu La �TL <br /> Fe-xTA-MIPM-El 1112131 <br /> 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />