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- Waste Tire 5 vey & Inspection Re rt SURVEY REQUIRED <br /> ■ ! Stale of CaliforniaLog= --- ----- <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPIInspection <br /> ll L _ �) ) I <br /> Site Suffix: / t / l Number: <br /> Site - Report a� <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - - <br /> ife �'m /�/ ' .n rbc.` <br /> ��,��, � �'1`�� --✓l�_�..J - ��, c�c�..s��s� /-tel - <br /> 42408 <br /> EXAMPLE, 123 ■ <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />