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■ : Waste Tire IS Vey & Inspection Wt ` SURVEY REQUIRED ■ <br /> •••�`: 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 /> TPID- Inspection <br /> Site Suffix: (S/ Z/ Report = ( — Z l r <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> I �D C �� ���d -�� c� � r��L�tilzc�,r► d{-�c�c <br /> YlsL.tC.�- "� �� �c�. r�rYl 2 v�.✓ �,�.Q-tc� <br /> AQ-35- <br /> o iue tc rz4 <br /> A ITS e I 1112131 42408 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />