Laserfiche WebLink
-- - --------- <br /> .......... .. ..... <br /> Waste Tire Survey Unspection Report inspection Report Number ■ <br /> State of California Survey Form - Page 1 <br /> CIWMB 181(New 04/04) 1143974 <br /> California Integrated Waste Management Board <br /> Part A-_SU llypy—_ __BLUE OR BLACK I-NK PEN- <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: Is 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 Inspected By Inspector <br /> Arv-yiaL)+c,- 46L�o Arvn6L,�� <br /> re <br /> Physical Ad ress <br /> Inspection Date 5 Is- <br /> Time In Time Out 0 AM <br /> Business Rep l Title 0 AM <br /> • CZ 02 0 PM 3 : 0 a Pm <br /> Zep ATrioAo <br /> Operational Status Tire Type Business Role Storage Type <br /> Z-0 (Fill one only) (Fill all that apply) (Fill all that apply) Storage <br /> all that apply) <br /> Tire Count(Whole/PTE) a <br /> 0 0 Active 0 Passenger Generator Outdoor <br /> 0 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler 0 indoor <br /> 0 0 inactive 9 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 /> V A HAWL-IN-13—A—PID MANIFEST REQUIREMENTS �0 Notice 0`f 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 (Required for NOV or EXT) <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 0 114 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 /> 0 0 Other: § <br /> Comments <br /> Inspection Form Included: 0' <br /> I <br /> G 7 <br /> Comments Included: ei Cri, _P 3 <br /> Busin s Rep's Signature Phone Number In i -ature Phone Nu-mber <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:9 incorrect: % E X <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Cop LE ® ■ <br />