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■ [;:_:Waste Tire SAiey & Inspection Rep SURVEY REQUIRED <br /> ■■■u. 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 /> TPIInspection <br /> Site Suffix:- � _ ` Report I — <br /> Site Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> 41w- <br /> I - <br /> i �t' ZTYI '�G� 2i- n/L41/LPVIR�t/Yn <br /> ��__ ���? p �✓sly,,� zz�� T_� � -� - <br /> t <br /> IE: XIA MIPI �IEI I 1 12131 42408 <br /> ■ e ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />