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Waste Tire Sevey & Inspection Rei t SURVEY REQUIRED <br /> •••�x State of California <br /> " CIWMI3183 (New 04104) omments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: / 3 Report = 1 _ D �j <br /> J Number: TT <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Ans <br /> trs�t r dot, /'rclal/ C r'�►'r2- rtivldycc.�1 <br /> �T ` Gt_�r1-�.r��!�/zr x,•n�, ,x'04 �irrrr �-r`rY' <br /> 04 0144UC, <br /> 42408 <br /> JE XIA'APILIE1 1112T31 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />