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■ rec_._ Waste Tire Sit fey & Inspection Repr J. SURVEY REQUIRED <br /> «. <br /> State of California <br /> CIWM8183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- p Inspection _ <br /> Site Suffix: i tC Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ?J <br /> _�r.�u•��}ani�rn.� 300 �,���,,�- - <br /> %1�0 <br /> Wry <br /> JE }CIA M P E 111273 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />