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Waste Tire S� ✓e & Inspection Re I <br /> "�� Y I7 SURVEY REQUIRED <br /> OHR! State of California <br /> CIWMB 183 (New 04104) Comments For„m 1 . <br /> CalifomiaIntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` / Inspection 1 L <br /> Site Suffix: <br /> 1 5 6 C> ` Report = , — ` 9 v lj 07 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> t.l <br /> vnn <br /> -"zc, <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA DO 7 1 <br />