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...JR Waste Tire S0. Inspection Report Numbere <br /> S SLC State of California <br /> CIWMB181I(New Manage Survey Form - Page 1 I 1 1088018 <br /> California Integrated Waste Management Board Y .J <br /> Bus ess P otftBLUE OR BLACK INK PEN <br /> Inspection Details -I <br />} TPID- ! Inspection Type (Fill one) <br /> Site Suffix ' 2 5 v ® Routine Q Re-inspection Q Referral Q Observation <br /> (.—�- <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: San .JUCiq<Alrl C.ourl�" <br /> Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> L_oS A m tqo_ S TL Serv1�Q.�_ <br /> 1 <br /> Physical Address J r t <br /> s I Z S S . Main zst. - <br /> Street <br /> r Inspection Date <br /> _�.._C-rAt 9 X33+6 <br /> City State ZIP Code Time In Time Out <br /> OPM f � AM <br /> Business;Rep :,.�/✓i. Title <br /> ii tle ) <br /> AM � <br /> _ � [I oPM <br /> O erational Status Tire Type BUSIneSS Role �tOYa€@ Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) 3" <br /> ® Active Q Passenger 3 Generator Q Outdoor <br /> Latitude f j 0 Q Closed Q Altered <br /> GPSQ Hauler Q Indoor <br /> �} Q Inactive Q Truck <br /> Lonitude <br /> g _ Q End-Use Q Container <br /> Q Planned Q OTR <br /> Business Type (Fill all that apply) <br /> 1@ New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> I* 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 /> V A HAULING AND MANIFEST REQUIREMENTS <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. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m 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 Q 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 /> 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 Compliance - No Violations <br /> Other: <br /> Q Q § <br /> Comments 'ROLA- nQ <br /> 1 1 r3�.GfitO �.e.'r�0'f rved 4 f S 4 7blL -U115LJ1T)Q Waicz peed • <br /> �tox . �qo �cas�e bites shored__ - Ike . F c% 1-�- $ 'Pad 11 <br /> rPa"� <br /> QSposgl -�or „SCA f;L +ine rmemoya\ GTL rnant Sts oye keen were <br /> 0V0,\A k7, "nY ielwknfl rQ t�e��- �o �/10-�t� Qn or coMern . <br /> Inspection Forme Included Qh VI <br /> ry <br /> Comments Included Q <br /> Number <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X '' ,a,'`M, P L E F <br /> 62081 <br /> eWhite Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />