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:Waste Tire S Vey & Inspection Rei t SURVEY REQUIRED ' <br /> •"'�` State of California <br /> CIWMB183 (New 04/04) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK IN_ K PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: C Repor: I <br /> 6 Number: I J q 39 <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> ev0 <br /> t CTL eos-A\ <br /> C V\d-w\e , <br /> IE IA MIPILIEI 1112131 42408 <br /> -11111 1 <br /> White Copy:CIWMI3 Yellow Copy:Operator Pink Copy:LEA <br />