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_ Waste Tire S fey & Inspection Re� t SURVEY REQUIRED <br /> � <br /> ■■•�•: State 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 /> /r Inspection -7TPID- � V � � � � � � � Report I /f — '� <br /> Site Suffix: Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - <br /> vI <br /> he_tet �&$fe JEi �Ic <br /> o r <br /> a � <br /> A T � � � � � 42408 <br /> Mtp Q <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />