Laserfiche WebLink
08206040172 <br />Q <br />Waste Tire Survey & Inspection Report Inspection Report Numbert.■MMB 181 (Nmla SurveyForm-Page1 I Z- 1 0 7 9 2 8 2 <br />ctwMe tet thew swat.Integrated Waate Management Board <br />-art A - ourVey IDLUc VR OLAt,r% Iron rcn <br />Business Profile Inspection Details <br />TPID - rII 2 Inspection Type (Fill one) <br />Site Suffix: 12 $ T - D / 0 Routine Q Re -inspection Q Referral Q Observation <br />Local If Referral, choosereferraltype (Fill one) <br />Identifier:� S�► . ��� Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br />Bus�17M `�-fi�cl iness or Facility Name V <br />/l Inspected By Inspector <br />Physical <br />; �QIVrG C�i/TfR- 13 <br />Physical Address <br />I 35 3 5 ,t4 A <br />I <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />- <br />Street <br />5,�,, <br />q� <br />Q <br />�S <br />Inspection Date <br />V <br />Q <br />ity �' /7 <br />C <br />Business RepTitle <br />State <br />SPS <br />ZIp Code <br />Time In <br />_F O AM <br />O PM <br />Time Out <br />FTI Q AM <br />Q PM <br />B ,COIV OJ/ <br />`/ <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Other: § <br />Comments V j I • _ Q_ _ e7 ,'1 _ 1 /7 <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE) <br />t <br />; <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />r <br />i r <br />0 Active <br />Q Passenger <br />0 Generator <br />Q Outdoor <br />Latitude L— <br />GPS <br />O <br />I— I <br />Q Closed <br />Q Altered <br />Q Hauler <br />Indoor <br />Longitude - <br />- I <br />O <br />Q Inactive <br />Q Planned <br />0 Truck <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />t <br />Q New Tire Dealer Q Auto Repair <br />Q Trucking Fleet <br />Q Government Q Retreader Q Dismantler <br />Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body <br />Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler <br />Q Agriculture <br />Q Shredder Other L✓/�. _/ L���� <br />Part B - Inspection.of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />14 CCR § 16459.1 - Tire Program ID Number from CIWMB <br />Q <br />14 CCR § 184592 1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Other: § <br />Comments V j I • _ Q_ _ e7 ,'1 _ 1 /7 <br />Inspection Form Included: U' <br />Comments Included: Q G I rte —Q6�3 <br />Business Rep's Signature, Phone Number Inspector's Signature Phone Number <br />62081 <br />INSTRUCTIONS ON BACK Cor ct: Incorrect: E X A M P L E !23 <br />■ White Co : CIWM Yellow Copy Operator Pink Copy LEA ® ■ <br />