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Waste Tire ey & Inspection Relowt _SURVEY REQUIRED <br /> ® __ • State of California - <br /> .'r CIWMB183 (New04/04) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details - - -- — - <br /> TPID- Inspection <br /> Site Suffix: \ _ 1 b Report >( <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> - <br /> ti <br /> X-1 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />