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4700 - Waste Tire Program
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PR0522556
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COMPLIANCE INFO
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Entry Properties
Last modified
2/25/2019 1:05:52 PM
Creation date
2/25/2019 11:23:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0522556
PE
4730
FACILITY_ID
FA0015366
FACILITY_NAME
FINE TIRE
STREET_NUMBER
4201
STREET_NAME
NEWTON
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
13207003
CURRENT_STATUS
02
SITE_LOCATION
4201 NEWTON RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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CField
Tags
EHD - Public
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• i,� <br /> Waste Tire Survey & Inspection Report Inspection Report Number <br /> State of California i} l/� <br /> CWMB grated 81steMana a Survey Form - Page 1 1 L - 1 025897 <br /> California Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details I <br /> TPID- )) (� Inspection Type (Fill one) <br /> Site Suffix: I 3 i D "j�} V ; ® Routine Q Re-inspection Q Referral Q Observation <br /> 1 Local <br /> ^ cowKi�, <br /> If Referral,choose referral type(Fill one) <br /> S 1(AIdentifier: tn IQ CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> I inspected By Inspector <br /> �i✓i t �'`�� 1 3 � - r 0 1 <br /> Physical Address ``� /� 7�tJt•1 Z. <br /> L+2.'p I Rd <br /> Inspection Date O y / � 3 � O 5— <br /> Time <br /> Time In Time Out <br /> Business Rep Title 0 AM 0 AM <br /> 0 PM 0 PM <br /> 1►i r5 �! VV j�C'i� Operational Status Tire Type Business Role Storage Type <br /> Tire Count(WholelPTE) <br /> (Fill one only) (Ril all that apply) (Fill all that apply) (Fill all that apply) <br /> � r <br /> Q Active I Q Passenger I Q Generator Q Outdoor <br /> O 4D Closed Q Altered <br /> Latitude <br /> GPS Q Hauler Q Indoor <br /> O Q Inactive Q Truck <br /> Longitude — Q Planned Q OTR ` O End-Use Q Container <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> ® Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q Other <br /> Part 13 - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ,ENFORCEMENT STATUS i <br /> A )HAULING AND MANIFEST REQUIREMENTS <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires Notice Of Violation Q Extension <br /> Q I O I PRC§42953-Contracts with Registered Waste Tire Haulers Compliance Deadline <br /> Q Q 1 PRC§42956-Registration/Decal in Vehicle I mOO 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements ` DateIE <br /> , / 171( jQ O1 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from !WMB IE 11 II II <br /> O i O 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days <br /> (Required for NOV or EXT) <br /> Q O 1 14 CCR§ 18459.3-Retention of Manifest Forms and Tire Trip Logs for 3 years <br /> O O 1 14 CCR§ 18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q ��,�VVMHn14j}41fmAAic. <br /> Q 1 Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> O 014 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ^+ <br /> 1 Q In Coritpllinoe No.,Aotatlone <br /> O Q Other: § <br /> Comments RtG 11f� tNQS SlOr i m LLS4 f Irk 5-' -For rots a le_ in Q ypt in i* — 1 <br /> StDo- e of -}j1;5 0je1C(resS. ptvHe✓, was eon1gCf:?_ot b - .le- 4one, <br /> he- rOw-t%n� iri.cpec+io-i , A1bQr4 -rine- i-s cdeiceased . 'BP us;vleSS 1s <br /> n-0 lon, r i n P1W=el'ori - T're-s viar2 sold -IV a,o vf her b u si h ess • _ <br /> Inspection Form Included: Q` �---- <br /> Comments Included: QI <br /> Business Rep's Signature Phone Number �n.p..t&s i nature Phone Number <br /> INSTRUCTIONS ON BACK Correct, lnaa 1I X�R_Nrj P <br /> -1-1�Z_I 3] szoal <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy.LEA <br />
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