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: Waste Tire °rvey & Inspection Ref rt SURVEY REQUIRED <br /> '_: • State of California <br /> CIWMB183 (New 04/04) %.Ijmments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile -� Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 7 - d Report �i S <br /> I _ ` > <br /> © � ! <br /> Number. Inspection <br /> � (0 6 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> - A012 1 12(rs �LY1 t !J�' LvKA r In'or Cde <br /> le <br /> 42408 <br /> xA.. PT� E >� 3 �� <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />