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Waste Tire vey & Inspection Rep-rt SURVEY REQUIRED <br /> J <br /> ■ ii� State of California <br /> CIWMB183 (New 04104) C umments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: /r 3 Z Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> -- -�O <br /> AV <br /> Sok <br /> - - - - 42408 <br /> 1EXIAMIPILIE1 11i273 <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />