Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
$$� Waste Tire Sut y & Inspection Report nspection Report Number <br /> State B California Il - 1140559 <br /> Cgrated 1stNew Manage) Survey Form - Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> ;Business Profile Inspection Details <br /> TPID- Inspection�� _ p / Inspection Type (Fill one) <br /> Site Suffix: / 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: /„ „V� 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected B <br /> p Y Inspector <br /> Physical A s <br /> Inspection Date / / 0 <br /> 64 <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> V o� o ® PM O 3 Q ® PM <br /> i - Operational Status Tire Type Business Role I Storage Type <br /> Tire Count (Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> `� S 0 Active 0 Passenger ® Generator 1 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler ® Indoor <br /> 0 0 Inactive ® Truck <br /> Longitude - 0 Planned ® OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 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 ® Agriculture 0 Shredder 0 Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility I ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> --- - --- - -- -- - 0 Notice Of Violation 0 Extension <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 /> / M <br /> / <br /> 0 0 14 CCR§ 18459 -Responsible Entities Complying with Manifesting Requirements Date m <br /> 0 0 14 CCR§ 18459.1 -Tire Program ID Number from CIWMB <br /> 0i014 CCR <br /> § 18459.2.1 -Submittal of Comprehensive Trip <br /> within 90 days <br /> (Required for NOV or EXT) <br /> 0 0 14 CCR§ 18459.3-Retention of Comprehensive Tri o for 3 years <br /> 0 0 14 CCR§ 18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CIWMB Enforcement <br /> 0 014 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities I <br /> 0 0 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators is In Compliance - No Violations <br /> 0 1 0 Other: § <br /> Comments <br /> Inspection Form Included: 01 <br /> I <br /> C1zo <br /> Comments Included:® - - --_-__- <br /> Business Rep's Signature Phone Number spector's Signatur -- <br /> e Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: X �/ ;EX A`M P L E i 1 2 3 62081 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />