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Waste Tire Srey & inspection Rei. t SURVEY REQUIRED <br /> •••'�� State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated,Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` Inspection <br /> Site Suffix: I 1 ' 7 ' 6 1 Report I Z 3 G a o <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Wvc � <br /> aver 2t o-c� r` . <br /> a�- <br /> :ve �h,4 <br /> cer�.c c� ys,r-rzf COP- <br /> ��- <br /> d�a�e <br /> S%k S <br /> v\ (ca <br /> V- S <br /> T <br /> 4'�( 61nn <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />