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I <br /> Waste Tire S". vey & Inspection Rep t <br /> - --- SURVEY REQUIRED ■ <br /> •••�� State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> LC _ Q Report = 'a 6 <br /> Site Suffix: ' Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 1-3-t/ /V t+Z �1f'S c c� ,i•� ✓YI r�I/L l`i�2 /3 <br /> 42408 <br /> f: xa �4P LE1 0 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />