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_Waste Tire S Vey & Inspection Rei. 't SURVEY REQUIRED <br /> •"'•: State of California <br /> CIWMB 183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - f , j G r(� Inspection n <br /> Site Suffix: "� � `� 3 � � v 6 Report = — .L 1 I <br /> Number: "I <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ccs!\ <br /> Sc, I S 1 <br /> 1 <br /> �11I,S CJ S c. 6�U f e{� ��1 4 V ,�'S �21 <br /> �,O <br /> 4- <br /> 1 <br /> 42408 <br /> JE XIA MIPILIE1 III3 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />