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Waste Tire urvey & Inspection R )ort SURVEY REQUIR� <br /> ■ ,, ■■■ta■ State of California — <br /> CIWM6183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspection <br /> Site Suffix: l .✓ lLl _ Ci Report I — ' 2- 4 s , <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 42408 <br /> JE A ni P I � EI 1112131 r <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />