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_:Waste Tire S4vey & Inspection Rer t 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- ^ I - ® Inspection <br /> C <br /> .LJ Report I <br /> Site Suffix: O Number: 3 ® -S J <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 3, >>� <br /> le XI <br /> 42408 <br /> AP� � t r <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />