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Waste Tire ��_ ✓e & Inspection rte_ <br /> ..._ - SURVEY REQUIRE® <br /> ScazS. State of California <br /> CIWMB183 (New 04104) Comments Form - - <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> siness Profile Inspection Details <br /> Inspection <br /> PT , 1 O 5 <br /> 5 V , Report J. - ul <br /> i Sitee Suffix: Number: • <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments - - - -- --- - <br /> - <br /> o <br /> t _ <br /> (A-� r It ll� <br /> s�101 0?,Lkj,leA- on \111 l oq (�.-4,) <br /> - In 0 <br /> - �F- t Z. GC, 5, <br /> GSJn�`s mS`� �U I mss <br /> 14T M� <br /> rl?Ms 'SUS,-c,�• •� P ��fl �'la—_ k1ck� -- <br /> CL <br /> 42408 <br /> [CXI AMS II L2131 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />