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EHD Program Facility Records by Street Name
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1019
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4700 - Waste Tire Program
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PR0524176
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COMPLIANCE INFO
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Last modified
6/26/2019 5:00:39 PM
Creation date
6/26/2019 4:12:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0524176
PE
4740
FACILITY_ID
FA0010328
FACILITY_NAME
MOUNTAIN VALLEY EXPRESS INC
STREET_NUMBER
1019
STREET_NAME
BESSEMER
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
22104067
CURRENT_STATUS
02
SITE_LOCATION
1019 BESSEMER AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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CField
Tags
EHD - Public
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Waste Tire Su & Inspection Rnsection Rt Nb <br /> on e or pReport Number <br /> State of California <br /> \ .- i 0 CIWMB 181(New 04/04) Survey Form - Page 1 0 - 10 2 5 t 80 l <br /> a - California Integrated Waste Management Board <br /> Part A- Su_rve BLUE OR BLACK INK PEN <br /> inspection Details <br /> TPID- i Inspection Type (Fill one) <br /> Site Suffix: ;E-1 / �- O r' ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local r _� _ If Referral,choose referral type(Fill one) <br /> Identifier: r= \,�_. <-i 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name "" <br /> Inspected By Inspector <br /> iJ <br /> Physical Address <br /> Street <br /> Inspection Date 1:19 <br /> _ J / E--E <br /> City State Lip Code Time InTime Out <br /> Business Rep Title _ O AM 0 AM <br /> ED : 0 PM : 1 0 PM <br /> Operational Status Tire Type ", Business Role Storage Type <br /> T@re CC?Bdn��WhO)e/1'TE); ® (Fill one only) (Fill all that apply), (Fill all that apply) (Fill all that apply) <br /> ® Active 0 Passenger 0 Generator 0 Outdoor <br /> Latitude <br /> � 0 Closed 0Altered <br /> GPS � •��� � � 0 Hauler D Indoor <br /> 0 Inactive 0 Truck <br /> Longitude — 0 Planned 0 O i R 0 End-Use 0 Container <br /> Btt ) x <br /> 0 New Tire Dealer 0 Auto Repair (a 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 <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> j 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 /> 0 0 14 CCR§ 18459 -Responsible Entities Complying with Manifesting Requirements Date <br /> 0 0 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB <br /> 0 I 0 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days (Required for NOV or EXT) <br /> 0 0 14 CCR§18459.3-Retention of Manifest Forms and Tire 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 @ 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> 0 In Compliance - No Violations <br /> 0 0 Other: § <br /> Comments ) <br /> Inspection Form Included: 0 <br /> Comments Included: 0 - - <br /> Business Rep's Signature Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:® Incorrect: X 62081 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> I <br />
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