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_Waste Tire *Vey & Inspection Re, ISURVEY REQUIRED <br /> •••'-`! State of California <br /> CIWM8183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - i 1 ' , 1 _ Inspection I _ ^ O Q 3 <br /> Site Suffix: 1 � l.�` Report ort y <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> kA-C 7]'RA�W <br /> C gA 4, WkS (AVO,'� A�Ac ifr- (�/O' <br /> Mu 1n � s ; ry�� <br /> so <br /> 4\ <br /> 1� <br /> jEXjAMjPj �JEJ 1112131 <br /> 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />