|
r
<br /> �1E_a Waste Tire S�y & Inspection Repo Inspection Report Number
<br /> State of California f; ■
<br /> CI' M6181 teManage) Survey Form - Page 1 ,� � 0 l 3 2 Z 6
<br /> California Intel rated Waste Management Board __-- -_
<br /> Part A- Surve BLUE OR BLACK INK PEN
<br /> TPID- Inspection Type (Fill one)
<br /> Site Suffix: Jmol
<br /> r �' ®}Routine 0 Re-inspection 0 Referral 0 Observation
<br /> LocalImo, If Referral,choose referral type(Fill one)
<br /> Identifier: 'j f.t J�f1['y fA,�r, C,E�14 +, 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other
<br /> Business or Facility Name Inspected B
<br /> 6P Y Inspector
<br /> I - IdZZ -_
<br /> Physical Address �A j �l – C C.. t-
<br /> t , 2 -2 i}
<br /> .% .,i
<br /> Street
<br /> �- qq Inspection Date n/ ,,J,
<br /> City State ZIP Code Time In _ Time Out
<br /> Business Rep Title AM 0 AM
<br /> ' 1 LoPM EEI : =1 0PM
<br /> Operational Status f o j Business Role
<br /> V C(Fill one only) �g41�1t (Fill all that apply) i ityy
<br /> r va„�
<br /> (0 Active �`}" � �� rr) Q,Generator
<br /> GPS
<br /> Latitude 0 Closed D �J� r�r l (1'nrfiryy .
<br /> i "- 0 Hauler
<br /> 0 Inactive
<br /> C gr,w
<br /> ar tr a L1 +a
<br /> urp ) yvr � a r
<br /> Longitude – 0 i� 0 End Use
<br /> Planned ��r 1tY
<br /> �:v
<br /> Kt 1w. - yY, i aw"t3i;. ' r t"� a1 l r tr ra"r�' 'N sJ I r y7f yaw I„ E;,13
<br /> Mei ar „EMd �M+A">T m ra' YiJ b1;ti "7 a�1'1„e � ,p+r�"-:; rv" r ::fil � � nr r 7,:* � a r +:++✓::.,,� r„,,.. �z �,re7,r.:(+E 9r , ✓t ,�-w
<br /> r
<br /> r`v,.�.h,.�..��,.d':�,�a:�.„...,,..�-..fir„ ,' �.2�: .�.J..h"'u...a�hb.��.rtwL"1..,,n.e,iu>u.x_..r„+. e��k .vM,atr44%,��rrr:��ae:R,E"�k.o.�.���..l�Gii.>.r•�`�a�n�.,.ta�1� .a,�:. �',�..v�...,J� '� n�: a��. r
<br /> 0 New Tire Dealer 0 Auto Repair Q 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 /> '-Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility i ENFORCEMENT STATUS
<br /> V A j HAULING AND MANIFEST REQUIREMENTS 0 O
<br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires
<br /> Notice Of Violation Extension
<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 (a)(b)(c)-Tire Program ID Number from CIWMB
<br /> 0 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 f
<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 0 In Compliance Na Violations
<br /> 0 ! 0 'Other: §+ �— ---
<br /> Comments
<br /> :(-. (.� I i ! ; t;T� F SC{
<br /> J41'� '�+ % �l I p C �}y�.t' VRAs�C ?t'' J I `sfi r"iy�J ct ! t�. � �, v r'.t ,� =
<br /> � r „c„�' �Y� - Yr �r �;;' 4� f»H��,.,. ,�� �'. ,»aP b,(> •u. �, w :,y�,s t,„rrMa7rr,r �l.w,�k,�h J,1 nr wit^fir” s ,t,r,...; 1;� fY�`., r a a 6'r rr
<br /> i ,r,,r.., � ,,,,' �vg...,,� r )r'•.rx„ ar 1� a q r+7,: l' !sF^py^a, '>r'^ a' ,w,�a�:v as �r1ha trri^ >7a r n: a+br 1+,
<br /> . v
<br /> ,..�y r.•r,: ,$ �r 3_., 'M")r✓a�°., ,:. aa�,+�r�:C:v ra a*„r w,r,; .. /: �. P+:�v:d r,..,wti ,a1 Yrw...pr�' n� �: aJ`` nYr �% , Y v:arX,: 1r�r, :7r;<;:. ,d;. �t »ka
<br /> p, , .9 pM „r,,. ,� � .»r.'t ,. � ~✓ ,,. � r t. .:� � r a d P�
<br /> .: :.,.f rr w�! ,. ,a,r N.,r. r �.,a,.:.,. C�'rm ,v � xr ,,,J r r: /res7~,6"I�"•a I ”t"eNn,�y" �, �.,a u,�4 w r-. r <,,.., t,!:C.,. g �:
<br /> M~ •rv7,.::ela drr r ..,a a + Y �4 ry1,: ,�' :re „r.4 � e.... ,�,22 r �y�.:.,�� ro � f”aI �7,a ,:+Yx..x > x, ,.,�r x 91� ')
<br /> 4 ,^ A r�'M h�11 b '�+a " °�y” � �"�,�+k 7r ,�"iW t �. ✓'iu
<br /> INSTRUCTIONS ON BACK Correct:. 62081 Incorrect: : ,NI, P
<br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA
<br />
|