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®Waste Tire S° fey & Inspection Rej 't SURVEY REQUIRED <br /> rs. State of California <br /> CIWMB183 (New 04104) comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business ProfileI Inspection Details <br /> TPID- / Inspection <br /> Site Suffix: 1 ! ` S $ - Q / Report I / _ I q I v �• S' <br /> Number: `f <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 6e0zzc, -4 <br /> —ice- !t" \ <br /> _ C � L2Q� end- Cwt l tt3 P S�-L�rc A 4-0 V1� y je.,r'C YC �`7 <br /> end <br /> Ar V4utsw S <br /> coym ,,,,�s pyx 3 — -- <br /> - - 42408 <br /> JE XIAAIP1 LJEJ I I Zn3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />