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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1333
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4700 - Waste Tire Program
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PR0523035
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COMPLIANCE INFO
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Entry Properties
Last modified
1/15/2020 10:32:27 AM
Creation date
1/15/2020 9:22:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0523035
PE
4740
FACILITY_ID
FA0000428
FACILITY_NAME
CENTRAL VALLEY WASTE SERVICES
STREET_NUMBER
1333
Direction
E
STREET_NAME
TURNER
STREET_TYPE
RD
City
LODI
Zip
95240
APN
SEE COMMENTS
CURRENT_STATUS
02
SITE_LOCATION
1333 E TURNER RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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CField
Tags
EHD - Public
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Waste Tire Survey & Inspection Report Inspection Report Number ■ <br /> Stagy°rCalifornia <br /> BoardSurvey Form Page 1 1 2 - 1008068 <br /> CIMB 181(New 04!04) <br /> Calitomle Integratetl WasteteManagement Board <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ^ „/ Inspection Type (Fill one) <br /> Site Suffix: / / O S 10 <br /> Routine Q Re-inspection Q Referral Q Observation <br /> Local cIf Referral,choose referral type(Fill one) <br /> Identifier: ��l K �. <br /> Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> BCusi ss or FacilitA7y Na Inspected By Inspector <br /> Pli�slcal Address <br /> /-333 cyl <br /> /fid% Inspection Date v/�� / <br /> ^7 <br /> Time In Time Out <br /> Business Rep l Title/ ` Z 0 AM 0 AM <br /> �Y1490Q �Q/�L` �F O ®PM 0 PM <br /> — Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill allthat apply) <br /> r ®Active ®Passenger ®Generator Q Outdoor <br /> GPS Latitude O Q Closed Q Altered <br /> Q Hauler Indoor <br /> 0 01 ti ®Truck <br /> Longitude <br /> Q Planned Q OTR Q End-Use I-0 Container <br /> Business Type (Fill all that apply) <br /> 0-New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler 0-Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber l <br /> Q Service Station Q Hauler Q Agriculture Q Shredder 0 Other <br /> Part B-Inspection of Waste Tire Dealer,Generator,Hauler and End-Use Facility (/ <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport of Tires <br /> Q I Q PRC§42953-Contracts with Registered Waste Tire Haulers. <br /> Q 1 Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements <br /> Q Q 14 CCR§18459.1(a)(b)(c)-Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§18459.2.1-Submittal of Manifest Forms and Tire Trip Logs within 90 days <br /> Q 0 14 CCR§18459.3-Retention of Manifest Forms and Tire Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers <br /> Q Q 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 <br /> Q Q Other: § <br /> Comments ( �jN irow ,1� <br /> �fi�� o <br /> 0 <br /> -- <br /> 'Inspection Form included:011 <br /> rr'I����� <br /> I Comments Included:Q _ '� •/7 <br /> B I ass ep's Signature Phone Number I spectoes Signature Phone Number <br /> ■ INSTRUCTIONS ON BACK M P ILTE1 '2 3 62081 <br /> x A <br /> White Copy:CIWMB Yellow Copy.Operator Pink Copy:LEA <br /> 0711604.0138 <br />
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