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q.- Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> ••"•' State of California <br /> �• CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board __ BLUE OR BLACK INK PEN <br /> tsiness Profile Inspection Details <br /> ID Inspection 1 <br /> Site Suffix: / g © Report I l — 1 6 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> r3vC <br /> See oc 6 -1 S S <br /> E42408 <br /> J� r4hhIl� L �i 1 � 3 <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />