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" Waste Tire *ey & Inspecti®�r� e� SURVEY REQUIRED <br /> •••3+ State of California - <br /> �" CIWMB183 (New 04/04) Comments Form <br /> CallfomiaIntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection (�— <br /> T / _ f Report I — J <br /> Site Suffix: r G I <br /> TPID- � � � Number: � e <br /> l, Inspection Number on the associated Survey form(Pag 1) <br /> Comments <br /> t X,&D <br /> 7-, - �TMS <br /> JL- <br /> 65 <br /> allTyuC <br /> 42408 <br /> IEXIAMIPILIEI Iflig <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />