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: Waste Fire ey & Inspection Rer SURVEY REQUIRED ■ <br /> State of California <br /> CIWMB 163 (New 04/04) <br /> Comments Form - <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 3 5 q - a Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> —L VdZ—t✓�G1lE'y�1zYt�_Q�' �t 4 r-a C 0 04^ Ccs n ce <br /> ,e r <br /> �. Yeci a° 1.1'ev. rtoo, Or <br /> all fes, f-►`c�.stJ . <br /> I—EXI A M P J B E I X 2 3 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA PT <br />