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Waste Tire purvey & inspection R,.--ortSURVEY REQUIRED <br /> _ State of California I---- ----L EZ - - ----- <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> Site Suffix: C, Report r J <br /> I <br /> Number: <br /> Inspect) n Number on the associated Survey four►(Page 1) <br /> Comments <br /> cctit;�` C� -b� a4- <br /> �3_ t4 w Lq 07 C1 12ap-A, Stoc�lbr) <br /> -+5 C I oCsz, TSD L,-i, It bA- c c,,yxd wfrd <br /> JE XIA MIPILIE1 111273 42408 <br /> t � <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />