Laserfiche WebLink
Inspection Report Number <br /> Waste Tire Survey & Inspection ReportS ate <br /> C;WM of California Survey Form - Page 1 i 1 - 1025649 <br /> Cgrated 81 t eManag 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: f -L +� 3 3 {- i O Routine Q Re-inspection Q Referral Q Observation <br /> i Local If Referral,choose referral type(Fill one) <br /> Identifier: ��l� �� � L N� Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address <br /> •2383 � ��r �32- <br /> � � <br /> 95'38� Inspection Date ,7Q' / C) CJ <br /> vCX r�,J f S C +�y cam' <br /> Time in Time Out <br /> Business Rep Title O AM O AM <br /> 0 P QPM <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 /> f f Q Active Q Passenger Q Generator Q Outdoor <br /> O 0 Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive Q 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 Q Trucking Fleet Q Government Q Retreader Q Dismantter Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> i <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 /> .... <br /> V' A HAULING AND MANIFEST REQUIREMENTS Q Nottcs`Oi 1/taltttton QI �ICyN,. <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires I <br /> 7 .eJ <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. ComplfenCs t�0adllne _,�'n <br /> Q Q 1 PRC§42956-Registration/Decal in Vehicle <br /> m l <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Nte I I 1 <br /> Q Q 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB I L 1 5 <br /> Q Q 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days (Rs qulretl foree <br /> Q Q 14 CCR§18459.3 Retention of Manifest Forms and Tire Trip Logs for 3 years 't-y �` "W. <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q:ii#rolPgS /t:I1l1E*MS � �' <br /> 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 r r % ` y� <br /> Other: § <br /> Comments � �(V'IG� S�i p� !'S I'tc7� (�tnl�'i'�-✓``I y � �/BICE <br /> �Yc�t-le�ss� ( •J <br /> Inspection Form Included: Q <br /> Comments Included: Q <br /> Business Rep's Signature Phone Number In s Si net a Phone Number ; <br /> - - <br /> INSTRI�OMON BACK Correct - <br /> i Inloorlract �{ J E_>6kMjPjLjEj 111213 62081 <br /> KB White Copy:CIWMB Yellow Copy.Operator Pink Copy:LEA <br />