Laserfiche WebLink
- 4�24305006f <br /> eee_ Waste Tire Su, ly & Inspection Repo Inspection Report ber,, <br /> State of 81(N California04,04) SurVe Form = Pag('�e 1 I 1 - 110 8 4 6 5 <br /> California Integrated Waste Management Board y "�J' <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: l I - 107___ • Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier- _ O CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or FacilityName -- <br /> Inspected By Inspector <br /> Physical Address <br /> Street f Inspection Date 176 <br /> O I CJ <br /> City Mate ZIP Code <br /> Time In _ Time Out <br /> . -- -— -- -- I .• ' Q AMBusiness Rep Title 0 A <br /> Q ® PMI1 : V I' / ® PM <br /> •96rvez �Y 1es- 0 -ri ed L—I _ � <br /> - Operational Status Tire Type Business Role Storage Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count (Whole/PTE) I <br /> f ® Active Q Passenger Generator ® Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude I Q Hauler Q Indoor <br /> . - -- — -- <br /> 0 Q Inactive ® Truck <br /> Longitude - I Q Planned ® OTR Q End-Use Q Container <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Is 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 ® Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORC-EMENT STATUS _ <br /> V i q HAULING AND MANIFEST REQUIREMENTS <br /> Q Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <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 <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 for NOV or FXT) <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 I 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 -ompIlance - No Viol10 1 ations <br /> Q Other: § ------ -- — <br /> Comments <br /> Inspection Form Included: Q <br /> Comments Included: —i- 6 <br /> Business Rep' I ature Phone Number Insp ct s ig tur Phone Number <br /> ON BACK C rrec : Incorrect: 62081 <br /> INSTRUCTIONS <br /> Exa � p '� E 1 :23 <br /> White Co y.Cl B Yellow Copy:Operator Pink Copy:LEA <br />