Laserfiche WebLink
Waste Tire SLS ey & Inspection ReporI Inspection Report Number ■ <br /> �I13iS1- State of CaliforniaCWMB T 1 <br /> iNew 04104) <br /> Calif Integrated d,Waste Management Board Survey Form - Page 1 11 1088310 <br /> Part A.Survey <br /> _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 44 Inspection_ 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: 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name - <br /> Inspected By Inspector <br /> Ayco Zrc ; ritual Co . <br /> cal Address <br /> cJa-4t km� Sfc- � � <br /> Inspection Date <br /> qS�L� <br /> Time In Time Out <br /> Business Rep Title O ® AM Q 0 AM <br /> / 0 PM 0 0 PM <br /> --- <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) 1 5 0 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Active ® Passenger ® Generator ® Outdoor <br /> 0 Closed 0 Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> 0 0 Inactive 0 Truck <br /> Longitude — 0 Planned • OTR ® End-Use ® 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 0 Agriculture 0 Shredder • Other <br /> Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility I ENFORCEMENT STATUS 1 <br /> V B HAULING AND MANIFEST REQUIREMENTS <br /> A <br /> H -- — - -- — Notice Of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> I <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 -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 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators 0 In Compliance - No Violations <br /> 0 1 0 1Other: § <br /> Comments <br /> Inspection Form Included: <br /> Comments Included: n " <br /> EkGsiness 's Signature Phone Number Insp c r s ture Phone Number <br /> INSTRUCTIONS ON BA M 1 .2 3 62081 <br /> White Copy.CIWMB Yellow Copy:Operator Pink Copy:LEA <br />