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Waste Tire C /ey & Inspection Rer 't SURVEY REQUIRED <br /> •••" State of California m <br /> CIWMB183 (New04104) `urnments Form <br /> CaliforniaIntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: r �j{ �►; y 0 / Report & 3 <br /> Number: T <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> - :�; ups �1� rrn� cam - work firL <br /> J - <br /> - Alr-y- 3 S7 . <br /> - <br /> t 2 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />