Laserfiche WebLink
--- 07312040027 ✓ <br /> W <br /> (Neer Oelee)aste Tire Survey & Inspection Report Inspection'Report Number <br /> State of Callrorrda survey Form - Page 1 1 5 - 1 0 7B 3 3 2 <br /> 1 <br /> CNYMB 181 llfornta Intsgnted Waab Mansgerrrrrt Board. <br /> Part Surve . BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ^ J O I Inspection Type (Fill one) <br /> Site Suffix: XV 5 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocaIf Referral,choose referral type(Fill one) <br /> Identifier: ( 0 CHP, 0 CIWMB 0 Complaint 0 Educational Visit 0 Other i <br /> Business or Facility Name os <br /> cInspected By Inspector <br /> _r,.1ess' m3q <br /> _ ! 0 Trahs� �zor ZhC� ! <br /> Ph a Addr <br /> 1-6-39- E. >De� Ave, i — -- <br /> Street �L Inspection Date <br /> r <br /> I I_ �I 95 <br /> City —Mate ZIP Code Time In Time Out <br /> Business Rep Title O AM Q AM <br /> QPM QPM <br /> L- —�— Operational Status Tire Type Business Role Storage Type <br /> Tire Count <br /> Whole/PTE i f 'u1 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ( ' 1 ®Active 0 Passenger ®Generator 0 Outdoor <br /> - — 0 0 Closed 0 Altered <br /> GPS Latitude 1:11, 0Hauler 0Indoor <br /> m O 0 Inactive ®Truck <br /> Longitude. - I I �,� 0 planned OTR End-Use Q Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair ®Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other I l <br /> Part B-Inspection of Waste Tire Dealer,Generator,Hauler and End-UseFacility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS 0 Notice Of Violation 0 Extenslon <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires . <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Data m/m / m <br /> 0 0 14 CCR§18459.1-Tire Program ID Number from CIWMB <br /> 0 0 14 CCR§18459.2.1-Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CIWMB Enforcement <br /> 0 0 14 CCR§18461-Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators IV In Compliance - No Violations <br /> 0 0 1 Other: § <br /> Comments (),�_/i- I_ c /S/� �) ,/J <br /> CQA 'i 1pre <br /> - <br /> 5fi;� vtsP -4�ce " a_6Gi..�,� �,,_�ateGC fe— et G�tie S_�0 . <br /> Inspection Form Included:0 11-� 9-�� �� 57 �A <br /> Comments Included 14 <br /> �6 <br /> Business Rep's Signature Phone Number Inso s Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: E-19AMPILIE1 11 2 3 62061 <br /> . White Copy:CIWMB Yellow Copy.Operator Pink Copy.LEA ® ■ <br />