Laserfiche WebLink
Waste Tire Surft & Inspection Report Mrspection Report Number <br /> State of California <br /> ClWMB <br /> 181 04104) <br /> Il - 1140704 <br /> California integrated Was eeManagement Board Survey Form - Page 1 <br /> Part A- _ _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- LA <br /> 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: GISOIZd U. 1A1r1 CoA .^ 0 CHP 0 CIWMB 0 Complaint0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> Tk I 1 <br /> (� <br /> Physical dx <br /> r ,s �Lry � 3 9 - ` 0 ) <br /> Inspection Date S <br /> I�ol�l� CA q SZN <br /> Time In Time Out <br /> Business Rep Title 0 AM C� 0 AM <br /> t l <br /> PM PM <br /> NL 'Ul an GG` _ S114413 ""`7` -- --- ---- - ----- --- <br /> - Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) 0 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> GPS Latitude <br /> O 9 Closed 0 Alt r 1)A 0 H�uT//����ebj 0 Iridool�d � <br /> O 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 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 <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> --------—-- -. —..- -------- --- ......................... -- <br /> -7v --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 /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date 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 ® In Compliance - No Violations <br /> 010 1 Other: § 1-u I <br /> Comments <br /> flS <br /> ��t u�lyA��'S /n r � '"` 761 1 wl <br /> 1 1t. W tnS 1 <br /> Tu is, I_ ( <br /> v:t \_S r^_ ,n �S�'s._ 1d1R/ <br /> tl l l 5 l i D -- `1 as l�. I,,,�er� �l o�w i r Q1 Fly►U>> S rn O�, (X ft, Close 1� <br /> Inspection Form Included: 0 <br /> Comments Included: 0 - - - a0 7_3-?6k - --` <br /> _ _ Business Rep's Signature Phone Number Insgnature Phone Number_ <br /> INSTRUCTIONS ON BACK Correct: Incorrect: JA MIPILIE1 1112131 62081 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />