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® �_. <br /> Waste Tire Sey & Inspection Re su�vEY REQUIRED !! <br /> :_ <br /> State of California ___:_ _-,__ _; <br /> CIWMB183 (New 04104) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile / Inspection Details <br /> TPID- <br /> / ,�r 1r Inspection <br /> _ r _ <br /> Site Suffix: Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> �7� V <br /> 75 2 <br /> S <br /> 42408 <br /> lexi-A—MOPME! 11 , 131 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />