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__ Waste Tire S• --vey & Inspection Rer -t SURVEY REQUIRED l <br /> a..► State of California <br /> L <br /> CIWMB183 (New 04104) GVmments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: <br /> 7 - C Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> VCS— kq `,4 l C ox <br /> 42408 <br /> EXA:hI� F L. E111273 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />