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= : Waste Tire S. vey & Inspection Re, 't i SURVEY REQUIRED <br /> State of California _ <br /> +•� CIWMB 163 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection <br /> Siete Suffix: U �� d Ll , Report <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 2 A-" C Tz- <ea-,C o-, W Gln r-,U✓t tit.e-4fgt fl!✓�-t , <br /> xg v L44 <br /> ,U4 -,�.2. �1��f, �l h.,-t� <br /> / <br /> -elf-4,--:Rj'e�4 <br /> , <br /> U <br /> II XIA MIDILIE1 I1I2131' <br /> ■ 42408 <br /> White Copy:CIWMB Yellow Copy.Operator Pink CoPY�LEA <br /> ■ <br />