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= Waste Tire Su. _ ;y & Inspection Rep( SURVEY REQUIRED <br /> •••'�' State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Q {n Inspection /� <br /> Site Suffix: 1 a v O ® I Report Number: I l 1 17 � O <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> N( V:S,41,m,to, <br /> 11 7 <br /> OxY1 C� f n,Cc�l, < <br /> S 1 <br /> 1J <br /> WtA P- <br /> t ► �e, <br /> �QN i eve _ <br /> 1l" <br /> 41C./-T4"rem <br /> � s _ o <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA r� 1 <br />