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Waste Tire Se,.■ vey & Inspection Rep A SURVEY REQUIRED <br /> ■ ■.■,.. State of California - _ - <br /> _mgzv_gz- CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board ---- -BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> /�,A, Inspection } s r,� <br /> Site ( lL) f v "� Report I l 4 �5J 9 <br /> Site Suffix: (� J Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 21 V,.�cam- --�; rya&L Sts <br /> 4 rl � <br /> 42408 <br /> FXAMP' L 1t12T31 Ir <br /> ■ White Copy:CIW MB Yellow Copy:Operator Pink Copy:LEA <br />