Laserfiche WebLink
1012SOS0042 <br /> - o, Waste Tire Survey Unspection Report Inspection-ReportNumber ■ . <br /> �r State Bof CaliforniaCI`NMI 1 114 3 5 7 7 - <br /> ew 04104) <br /> California Integral df81 Wast+e Management Board .Survey Form Page 1 <br /> Part A- Survey__ BLUE OR BLACK INK PEN <br /> Busiriess Profile T�T Inspection Details <br /> TPID- r I l O ^ I Inspection Type (Fill one) <br /> Site Suffix: It I`-( I p� ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one). <br /> Identifier: �Q�✓�. lC�v1� C-E�iJI(i Q CHP Q CIWMB Q Complaint . Q Educational Visit Q Other <br /> Business or Facility Name ` Inspected By Inspector <br /> 13�ct o _ �Physical Addresd <br /> 137 8 q� <br /> Street <br /> �+ E4 ca g5acs Inspection Date <br /> CiL ty State Z/P Code J Time In III III��� Time Out <br /> Business Rep Title �I - Ir .'0 AML— 0 AM <br /> C)l®PM pC� A PM <br /> L J��oY1_.-C✓O� foY1 _,�t��-,vhf- -- <br /> Operational Status Tire Type Business Role .Storage Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) <br /> Q Active. Q Passenger ®Generator Q Outdoor <br /> Latitude ® Closed Q Altered <br /> GPS { I O Hauler ® Indoor <br /> �I—� .t { �-- —� Q Inactive ®Truck <br /> Longitude i i- r I I Q Planned Q OTR Q End-Use Q,Container <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer . Q Auto Repair ®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 I I <br /> Part B=Inspection of Waste Tire Dealer,Generator, Hauler and End-Use FacilityENF-ORCEMEN1T SjTfA�TLU3 <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> Q Q Q Notice Of Violation Q Extension <br /> PRC§42951-Waste Tire Hauler Registration and Transport of Tires ^' <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q 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 -Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days �t,(Required for NOV or <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years - t <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CIWMB Enforcement <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 ®In ompliance - No'Violations <br /> Q Q Other: <br /> Comments <br /> Inspection Form Included: Q 001, <br /> ,�/1 c Q� <br /> Comments Included: — — -- '1���J - — -7%97 K�7 <br /> slness ep' ature. Phone:Number in' e r i atu�e :r:= .,Phone Number <br /> �� 62081 <br /> INSTRUCTIONS ON BACK Cor ect: co"rrect: ;'� +' �,X �t� P. 111213] <br /> White Copy CIWM Yellow Copy.Operator Pink Copy:LEA ■ <br /> I <br />