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Waste Tire y & Inspection Re <br /> SURVEY REQUIRED <br /> -- i <br /> •"'`• State of California <br /> "�- Comments Form ` <br /> CIWMB 183 (New 04104) <br /> Cal iforniaIntegrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspectionReport <br /> / J <br /> Site Suffix: CI y Number: <br /> Inspection Number on the associated Sur vey form(Page 1) <br /> Comments <br /> cf- :f�2 <br /> .� JP�l-� - <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />