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vr t <br /> Waste Tire ey & Inspection Rer SURVEY REQUIRED <br /> ■ "as _ _ ■ <br /> •••'•• State of California <br /> Fa' CIWM8783 (New04l04) „ ments orm <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 .3 J y Q C) / Report = _ j L 0 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �os.� u�f-�`cnr►s_ rnrct_r _—c� C CM Cd -v�, <br /> 3r►rt.C,17�V U Cera/ E't'L+�. _ln <br /> t S PLL p G<C.fLIJG - /�(�1'Ia 2Gx r—�,C=�21, yP,- <br /> LAS }i ne Ct'a-Pa r"A OCe -�'1 t .21.�� .'LfJ i 1 rear - <br /> Q On C 01 jAI-)'6 S+r- 41M V1r1Ciltr�i k f+ tgh We � ��t lfetJrS <br /> ►1R]:4-4N 41LY jQ-r� 4t i 1%/I-eA^/ <br /> Coll <br /> Gn <br /> e 7C A I P I (rTE;' 1—12T-31 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />