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■ __ <br /> Waste Tire Ala & Inspection R I SURVEY REQUIRED <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 /> TPID- Inspection _ 1 .1 <br /> � -7 6 <br /> Z <br /> �-y Report = ..L . 3 6 J <br /> Site Suffix: � v l Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments&Lj <br /> - <br /> tr <br /> til , 1 <br /> A ex <br /> 1 6 s �m <br /> Z <br /> 7 a v20 �-- <br /> Ve <br /> � �� <br /> V 4 <br /> �-.^" :i j2 `)c, t <br /> 0 JA <br /> 42408 <br /> 14 KP ® ■ <br /> ■ <br /> White Copy:CIWMi3 Yellow Copy:Operator Pink Copy:LEA <br />