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Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> ' State of Callfomie <br /> CIWMB IBJ(New 04104) Comments Form <br /> California lntegmtod Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile _ Inspection Details ..r. <br /> Q Inspection � fi��o(LL' c^ <br /> TPID- J ! r Report I 1 Q r _i (/ <br /> site suffix: ! Number: <br /> Inspection Number on the associated Survey form{Page 1 J <br /> Comments <br /> — - —— 42408 <br /> F1x AES P z z <br /> White Copy.CIW MB Yellow Copy Operator Pink Copy.LEA <br />