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LWaste Tire SL ey & Inspection RepSURVEY REQUIRED <br /> •__'�! St ate 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- A 7 ---_ ® ' Inspection _ ` O <br /> Site Suffix: Report ✓` <br /> I <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> a-,rw <br /> SQ Vne <br /> yes,-le XIA MIPILIE1 111273 �S. <br /> 42408 <br /> t <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />