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Waste Tire S&ey & Inspection Rept SURVEY REQUIRED <br /> •••�;• State of California <br /> �r CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - 1 d t ` i Inspection _ I <br /> Site Suffix: "� ` Report I <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments lit <br /> le XIA <br /> +'IPILIE1 1112131 42408 <br /> ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LFA <br />