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Waste Tire S Vey & Inspection Rei I SURVEY REQUIRED <br /> State of California Comments eats Form -I <br /> CIWMB 183 (New 04/04) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> _� — Inspection 2 <br /> w <br /> TPID- �7 q 2 � e � Report I , — �, "� C�1 <br /> Site Suffix: 7 7 Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2 cQeLr, 1 MA-* <br /> 5. - i <br /> E XIA MIPI L E1 11 a I I 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />