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°sao� Waste Tire S.-. ✓ey & Inspection Repo. _ Inspection Report Number ■ <br /> State I3 California I 1 - 1143606 <br /> Cgrated Waste <br /> eManage) 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- Inspection,tom Inspection Type (Fill one) <br /> Site Suffix: 3 / l 6 I � V l 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: l/� �r✓Y�Vl. 0 CHP 0 CIWMB • Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> �V;CL Auto <br /> Physical Address !7L;ZN1Sf� 1m b;�l� <br /> 1701 — <br /> Inspection Date 3 { O <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> 0 ! PM c2 PM <br /> rf i ,lN --- - - - -- -- - - - <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 all that apply) <br /> ®Active ® Passenger 0 Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use Container <br /> Business Type (Fill all that apply) _ <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 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 /> Vj A 'HAULING AND MANIFEST REQUIREMENTS <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires Notice Of Violation 0 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 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date [ / V Mto <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <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 - No Violations <br /> 0 0 Other: § <br /> Comments <br /> Inspection Form Included: 0 <br /> Comments Included: i' �J-v- u-`5-ko +��g�� �� <br /> Business Rep's Sign ure Phone Number I cto s Ignature Phone Number <br /> INSTRUCTIONS ON BACK Correct:9 Incorrect: X �j J ? p (� 3 62081 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />