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Waste Tire <br />•�• State of California <br />CIWMB183 (New 04/04) <br />California Integrated Waste Management Board <br />S&ey & Inspection Rep t <br />Comments Form <br />SURVEY REQUIRED, <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />' © 1 1 7' Inspection 307 <br />0 7 3 / 1 <br />TPID - � _ Report = — I _ L <br />Site Suffix: Number: <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />cgs <br />2�cG� Uo�n-�ik 4- -eNV V Wit, 0 - <br />---�� <br />CIN <br />o (b14► .� v�e <br />c <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />