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Waste Tire S@Vey & Inspection Rep t SURVEY REQUIRED <br /> •••��; State of California <br /> CIWM6183 (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: Report I <br /> 1 ` d b g V 1 Number: 1 2 G a 3 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �,�5 . <br /> t l <br /> A Ir <br /> a� ?-C> <br /> y• e�cr�c���a� <br /> r <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />