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Waste Tire S vey & Inspection Re -t <br /> SURVEY REQUIRED <br /> StateofCalifornia <br /> CIWMB183 (NewO4/04) Comments Fort l►y�l <br /> California Integrated Waste Management Board BLUE OR BLACK INK P E N <br /> Business Profile _ Inspection Details <br /> TPID- Inspection <br /> Site Suffix: l y 2 S O Report I , - Q : Z Z <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> i <br /> --CO --. -C�d�f <o . S � ' --G� DY7 c.ie,-4L t 3 <br /> —k3 C <br /> rj 25-71 <br /> 42408 <br /> IllP1 I ' <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />