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Waste Tire S e & Inspection Re �t - <br /> c'- Y p [ SURVEY REQUIRED <br /> Le 'i'I 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- II Inspection <br /> Site Suffix: l 6 5 7 1 Report I I — ` 2 � 2 1 3 <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> E! r-.mss CIL& e c ss_« c �r eac Sr <br /> W,4Q <br /> & <br /> �o ca�� <br /> 42408 <br /> r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />