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7;--M Wastea Tire urvey & Inspection F ?ort SURVEY REQUIRED <br /> State ofCIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> siness Profile Inspection Details <br /> inspection /f �j ] <br /> PID- -�' Report I — ® V <br /> Site Suffix: 1 V Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> A ��.:���- f'a'n ce�-► <br /> r <br /> Inn <br /> 1 <br /> CA-e✓�" YVI�a SSC ►1/1 <br /> LC <br /> 42408 <br /> EIXIAIMIP <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />