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AWaste Tire S ley & Inspection Rer t iFSURVEY REQUIRED <br /> IState of California <br /> k - - <br /> CIWMB183 (New 04104) Comments Form <br /> Califomialntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- + inspection c <br /> Site Suffix: 6 Repori I — 2 � 'lir 19 2 2 <br /> Number: <br /> Inspection Number on the associated.Survey form(Page 1) <br /> Comments <br /> k-qiz-057yv1%11 " Aok-cV 'C-Nx-,P,_ <br /> Civ-('"� <br /> - � cP -4L <br /> jEXjAMjPj �JEJ 1112131 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA r� <br />