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Waste Tire Sac & Inspection Rer i SURVEY REQUIRED <br /> ■ ..... <br /> LIZ <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 /> SiteTPIDS - H _ O Inspection _ S <br /> Site Suffix: I Report = u 3 y <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> WAC,�I cCIS Com 1�(.3MAS 1 t�4 <br /> s s r <br /> 'oj <br /> _ A0 <br /> Ala/ <br /> IE XIA MIPILIE! 1112131 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />