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Waste Tire S ✓ey & Inspection Rei, t SURVEY REQUIRED <br /> •::•� State of California <br /> CIWMB 183 (New 04104) <br /> Comments Form -- - - <br /> - - <br /> CalifomialntegratedWasteManagementBoard BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection L� <br /> Site Suffix: 1 © 1 Report .2 <br /> Number: T <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ayez:A o� 6"1 <br /> 14 <br /> bur, c ocs <br /> ►'yt :(a C G�7 G'e't <br /> 42408 <br /> I: XIA MIPI LL It 12n3 : ■ <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />