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EHD Program Facility Records by Street Name
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4700 - Waste Tire Program
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PR0524140
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COMPLIANCE INFO
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Last modified
3/8/2019 1:48:14 PM
Creation date
3/8/2019 11:38:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0524140
PE
4740
FACILITY_ID
FA0016218
FACILITY_NAME
DELTA MATERIAL SUPPLY INC
STREET_NUMBER
1920
Direction
E
STREET_NAME
PARK
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19809013
CURRENT_STATUS
02
SITE_LOCATION
1920 E PARK ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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CField
Tags
EHD - Public
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Waste Tire Suy & Inspection Repof' Inspection Report Number ■ <br /> ■ <br /> WM <br /> State of CaliforniaCIWMB 181(New 04/04) Survey Form - Page 1 1 7 . 10 1 0 5 8 1 <br /> California Integrated Waste Management Board - ---- -- -- <br /> Part A Survey BLUE OR BLACK INK PEN <br /> Inspection Type (Fill one) <br /> Routine Q Re-inspection Q Referral " Q Observation <br /> Local r1 If Referral,choose referral type(Fill one) <br /> Identfer: Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name t Inspected By Inspector <br /> f <br /> t t <br /> Physlcal Address ��-1� C ) 1 – !t lY <br /> Street Inspection Date <br /> .,� <br /> City �} State ZIP Code Time In _ Time Out <br /> Business Rep Title M <br /> (] AM O AM <br /> / t � ��0PM M <br /> � 0P <br /> N it <br /> t, � � i i I ��(� Operational Status r t �F �„ Business Role <br /> (Fill one only) ��G�l(r b (� �� (Fill all that apply) <br /> El Lu---- <br /> Q Active a � �,� Q Generator <br /> �a fr € trot wry <br /> C Q Closed �� It �Ii"f !T,p <br /> Gps Latitude err"df(r ! ''t Q Hauler <br /> �� mfwr <br /> O <br /> Inactive <br /> Longitude Q Planned r � Q End-Use <br /> Q New The Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber / <br /> Q Service Station Q Hauler Q Agriculture Q Shredder (S Other Q ( ! t ((,'. ' f i.;i <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUSm <br /> V I A HAULING AND MANIFEST REQUIREMENTS <br /> Q Notice Of Violation Q Extension <br /> Q Q <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of TiresY', <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days (Required for NOV or EXT) <br /> Q Q 14 CCR§18459.3-Retention of Manifest Forms and Tire Trip Logs for 3 years <br /> Q Q 14 CCR§ 18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred f CIWMB Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> Manifest- System Requirements for Tire Dealers or Waste Tire Generators <br /> Q Q 14 CCR§ 18462 In Compliance No Violations <br /> O O Other: § �w <br /> f <br /> Comments j��v{ li -i jl f. ���. /vu ,tri F% - � �r �,(�✓�/�`; <br /> j. <br /> Inspection Form included: QL <br /> Comments Included: Q <br /> Business Rep's Signature Phone Number Inspector's Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:® Incorrect: X I ;;A V.i I_ i � I�L �g <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />
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