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:: Waste Tire <br />•••'+: StateofCalifornia <br />kaCIWMB 183 (New 04104) <br />California Integrated Waste Management Board <br />,90ey & Inspection Ret t SURVEY REQUIRED <br />Comments Form <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID- t Inspection /�1 <br />Site Suffix: I S 1 1 Report I — I 2 3 V Z Q y <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />` ZZ) <br />C C l Y\ in <br />Ce -c,- v i W\R- eIr 4e' <br />-ver CX- V,Qrl n Q�� <br />o <br />.:� 1 CCA--, or) t <br />White Copy. CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />