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Waste Tire Su, ,y & Inspection Rep SURVEY REQUIRED` <br /> M Ce <br /> s �••'�• State of California 'J <br /> CIWMB183 (New 04/04) Comments Form - - <br /> CalifornialntegratedWasteManagementBoard BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Report <br /> Site Suffix: `f 0 (U - I / — ` 1 /•� �, <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> it,-, a + <br /> - ori5 -e- <br /> 1 n <br /> M1 <br /> 74K l' __ ✓f' �C.�' <br /> 42408 <br /> le AMjP;MEj 1112131 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> r ~' <br />