Laserfiche WebLink
Inspection Report Number <br /> Waste Tire Su. ,y & Inspection Report p p <br /> rliL State of California <br /> Cgrated Waste <br /> eManage) Survey Form - Page 1 1 Z - 1 0 7 9 2 0 0 <br /> California Integrated Waste Management Board <br /> Pati A- Survey- BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> -7 <br /> Site Suffix: 2- / 1 o U y 1 U I 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: Sart ToQq on C(:)Uf j Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> SchneicLor Nck- (On GI , =nc . 2 q _ <br /> Physical Address ` Gri5t\Ct <br /> 1� n Lucas <br /> 161 Trnr\GPor+CAti on Gt <br /> Inspection Date Q 3 � Z G � Q <br /> �rrerlc,h Game GA 95Z31 <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> 46p-" i1 1 O PM O PM <br /> Lee �}erre,n — T\r� 5 G10.tISi Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) 3 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 0 Active Q Passenger •Generator 0 Outdoor <br /> Latitude <br /> O Q Closed Q Altered <br /> GPS Q Hauler Q Indoor <br /> O Q Inactive 0 Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair 4W 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 /> Q Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. j Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> QQ 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT),;; <br /> Q O <br /> 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 /> I. <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 40 <br /> In Com Bance. to<�l�olatlo 1 <br /> Q 1 Q Other: § <br /> Comments 1 <br /> �au-ttlt�� upsaec-�'Wn AcaLe.� orMtA -t-htS $ t I1owi1 ��5 nr "ecl <br /> j:CtLAALII r )as-ky- +iy. h)QtAt_ylq � re+(r.eiry�C-es CTi� <br /> irnant -A- �a_�it (ilasA-e. ern, Y�P_mmdar Aje re re+cktne 4- a)jfattGbl-0 -�Y �- <br /> XAW Qc7T• V 1 orCO erre <br /> Inspection Form Included- oil 27 <br /> C2� <br /> Comments Included: � --- 0Z� -- — �`(6g� 31�� <br /> Business pcs s Signature Phone Number In ec r s Signature/' Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK � afi ' ' 3 I�AMP ; <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />