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Waste Tire S vey & Inspection Rei A SURVEY REQUIRE <br /> •=�=Z_! 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 Report I 1 q <br /> / <br /> Site Suffix: , 3 .1 E t Number: T <br /> Inspection Number on the associated Survey form(Pagel) <br /> Comments <br /> A• _ y <br /> " e J <br /> �� ►vlw rMs cx rA� b� tr✓ i <br /> 5^ Fa -J Jz d a <br /> IF <br /> AMID LE� rj ? 3 42408r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />