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-. inspection Re, t <br /> --P;_ <br /> —y Waste Tire ey & sp suRvo=Y REQUIRED <br /> �+• 4• State of California _ - - - -- - <br /> CIWMI3183 (New 04104) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile 1 Inspection Details <br /> TPI -— Inspection <br /> Site - - --- I <br /> I _ l <br /> Site Suffix: ReportNumber: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �WIP 1 :2408 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />