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Waste Tire S ey & Inspection Rep SURVEY REQUIRED <br /> LUSState of Comments Form <br /> CIWMBWMB183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 _ Inspection _ 1 <br /> V� Report I <br /> Site Suffix: l Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> rN. 4mft^JS <br /> �X50-A w Xkc_co, - W_exq— <br /> CA),N.K 6e a, "C'9-%A\ 6� <br /> 42408 <br /> E A S 11Z <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />