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:Waste Tire SL ey & Inspection Rep SURVEY REQUIRED <br /> ••��: State of California <br /> • CIWMB183 (Slew 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Q <br /> Report I 7 7 6 l <br /> Site Suffix: <br /> 1 3 g 2- \ Number: I <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2� � ��V Sac-�1r. r�.�•,r� �a� �,.tS �-c.�c�1:�i <br /> b.Y•c�. Q,a��l a�l e_ �c- re v�ew -�c- � ��c��'�_ <br /> IE; XIA MIPI LIEI 1112131 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />