Laserfiche WebLink
osai ��4oao6 <br /> - Waste Tire Survey & Inspection Report Inspection Report Number <br /> - •— <br /> �8 State of California I 1 108694.3 <br /> Cgrated 1steManag) Survey Form Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey' BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1_5 I- _ [�Y_ Inspection Type (Fill one) <br /> Site Suffix: Is Routine Q Re-inspection Q Referral Q Observation <br /> Local �� 0 �l n If Referral,choose referral type(Fill one) <br /> Identifier: ` - Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name — <br /> Inspected By Inspector <br /> 40 <br /> Physical Address <br /> Street /� Inspection Date <br /> �S- orb n C/}�1 <br /> City State ZIP Code Time In Time Out <br /> Business Rep Title (� S AM A-6-1 --L <br /> u 7 e AM <br /> 0 PM !5 I 0 PM <br /> - Operational Status Tire Type Business Role Storage Type <br /> The Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Active Passenger ®Generator Outdoor <br /> ~ O Q Closed Q Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> -- -- — - - Q Inactive Q Truck <br /> _ <br /> - -- - --: __.. O <br /> Longitude - , ; I Q Planned Q OTR Q End-Use Q Container <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer 41 Auto Repair Q Trucking Fleet Q 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 Q Other <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V M HAULING AND MANIFEST REOUIREMENTS <br /> Q Q Q Notice Of Violation Q Extension <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. C-omplia ce Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements at <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> Q O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or DiT) <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/CIWMB Enforcement <br /> Q O 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 Compliance - No Violations <br /> Q 1 Q 1 Other: § <br /> Comments -- �nQ' ��-'_'C--"'��!t- ��-li.�U\-'- IS-`�\�J K — - Q VW�� ^^^'_+'. t <br /> 1 <br /> (\0vtD�u- _\vgs__Q�C ,r_cAs-o 'C1JnC�-C11. - <br /> �( `• �- bra 11� -1 c�-a-0 =1-��, 1..=�521T 1a�l,l�� fQf is 5 LLS c�,�► �— <br /> Inspection Form Included: Q 74 r,, y <br /> Comments Included: Q ����_mbr- <br /> 3 <br /> Buslness p s i Phone Inspe ors Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Cor eta: neorreta: X M P L 111Z 3 <br /> ■ White Copy. IW Yellow Copy:Operator Pink Copy:LEA <br />