Laserfiche WebLink
_ 08234040043 <br /> =- Waste Tire Survey & Inspection Report Inspection Report Number <br /> LLq Stat-or Carrforw SurveyForm - Page 1 I.1 1088173 <br /> CIWMB 761 stew nage a <br /> California Inleg2ted Waste Management Board J <br /> Part A-SU V BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- G Inspection Type (Fill one) <br /> Site Suffix: 19 Routine Q Re-inspection Q Referral Q Observation <br /> LocalH Referral,choose referral type(Fill one) <br /> Identlfler. J �l•� Uj Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Phys' ca�nddess/sy Atit-'moi✓_�_ceJ 3 Q _ <br /> MotFL :l_ 1AR�aJ� <br /> Street Inspection Date <br /> City Q State Zip Code Time In Time Out <br /> Business Rep Title Q AM0 AM <br /> O PM EU 0 PM <br /> Operational Status Tire Type Business Role Storage Type <br /> The COUnt(WhOIeIPTE) (Fill one only) (Fill all that apply) (Fill all thafapply) '(Fill all that apply) <br /> 41 Active Passenger •Generator 0 Outdoor' <br /> Q Closed Q Altered <br /> GPS Latitude i I Q Hauler Q Indoor <br /> Q Truck <br /> Longitude Q Planned Q OTR Q 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 /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Service Station Q Hauler Q Agriculture Q Shredder Q Other I I <br /> Part B-Inspection of Waste Tire Dealer,Generator,Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING ANI)MANIFEST REQUIREMENTS <br /> Q Notice Of Violation Q Extension <br /> Q Q <br /> PRC§42951-Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§142953-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 <br /> Q Q 14 CCR§18459.1-Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§18459.2.1-Submittal of Comprehensive Trip Logs within 90 days (Required/or NOV or EX77 <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CIWMB Enforcement <br /> Q Q 14 CCR§18461-Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire-Dealers or Waste Tire Generators In Compliance - No Violations <br /> 1010 Other. § <br /> Comments __ /n/S__iN�.��`�—eY_r_/�d�.___���-�OW'!'�r±�L✓oLq—�D�•- <br /> -/ k.J <br /> J6 7r <br /> Inspection Form Included:Q <br /> Comments Included:Q ="=Q6W <br /> Bust�..�Rep'. Sign.;ature Phone Number Inspectors Signature- Phone Number <br /> INSTRUCTIONS ON BA -orrect:� InMellow <br /> EXAMPLE 1 2 3 62081 <br /> ■ Whl Cop IW FB py Operator Pink Copy.LEA ® ■ <br />