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d Waste Tire SMey & Inspection Re SURVEY RtQVIRED , <br /> YYY State of California <br /> CIWMB183 (New 04/04) mments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: I 5 - Report <br /> 1 O I Number: J O <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 04 C,bnlccrn fCcmine���pn On Sjq j0j <br /> 111 E P Lj Ej Ifli-T31 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />