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i <br /> Waste Tire S ey & Inspection Rep t SURVEY REQUIRED ' <br /> +-,:: State of California' ' <br /> 11 �`+ CIWMB 183 (New 04/04) <br /> Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile, Inspection Details <br /> TPID- —� ( Inspection <br /> Site Suffix: a - Report I <br /> Number: <br /> - Inspection Number on the associated Survey form(Page 1) <br /> _Commeits y <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />