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Waste Tire $Oey & Inspection R SURVEY REQUIRED <br /> '= :.aE <br /> ,.� State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board_ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 3 c) �? a 14 Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> v�ela�S ar -"lkworccr Of C_aXICe r n.- <br /> �J�ks + . <br /> 0(n -4z,&nle /2,�i�ci✓�� <br /> L9 7? 57 <br /> a <br /> Estvd rG ii` t Y, fS 6ZZZ[.r& 441d C 2m <br /> d;c_�i c�,v�1 - brayi r1w -JE - <br /> 42408 <br /> }� A N, FIL 1117iR3 <br /> i <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA F: d <br />