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^:.:Waste Tire Survey & Inspection Report <br /> SURVEY REQUIRE <br /> State of ornia <br /> CIWMB 83't(New 04/04) Comments Form -- <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Aness Profile Inspection Details <br /> D Inspection <br /> Site Suffix: I / Q / Report I — -2 C� U b Number: L 1 1 I <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> QN IV �S <br /> C"So -- <br /> W�.ean <br /> R- <br /> a co '�;�'e.S t�v�S� . '�e� w.�r. • S <br /> 42408 <br /> E : AMP l Z 2 3 -� <br /> ,�■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA �_ <br />