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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MACARTHUR
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2650
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4700 - Waste Tire Program
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PR0524576
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COMPLIANCE INFO
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Entry Properties
Last modified
4/2/2020 4:00:05 PM
Creation date
4/2/2020 3:01:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0524576
PE
4740
FACILITY_ID
FA0003941
FACILITY_NAME
ORCHARD SUPPLY HARDWARE #1570
STREET_NUMBER
2650
STREET_NAME
MACARTHUR
STREET_TYPE
DR
City
TRACY
Zip
95376
APN
21307061
CURRENT_STATUS
02
SITE_LOCATION
2650 MACARTHUR DR STE A
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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CField
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EHD - Public
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Waste Tire Su & Inspection Repor spection Report Number <br /> -7ID�3,S8 State of California - r.. - ■ <br /> CIWMB 181(New 04104) S ey Form - gage 1 �` a U <br /> California Integrated Waste Management Board - <br /> Part A- Survey _ BLUE OR BLACK INK PEN <br /> Busttless Profile ' Irrspectto i Details <br /> J <br /> T?ID- _ p Inspection Type (Fill one) <br /> Site Suffix: + f <br /> Q Routine Q Re-inspection Q Referral Q Observation <br /> Local V _i If Referral,choose referral type(Fill one) <br /> Identifier: <br /> F;.�:�' _ � Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address <br /> i <br /> Street <br /> Inspection Date <br /> Business Rep _ __..—__ —..-- S, Time G"ocPe Time In Time Out <br /> Title _.. 0 AM , EL- <br /> Q AM <br /> QPM0PM <br /> Operational St sa utut Tire Type O <br /> ole Storage <br /> Type e <br /> (Fill one only) (Fill all that apply)! (Fillall that app Y) ( alapply) <br /> Q Active Q Passenger Q Generator Q Outdoor <br /> _ _ M ` ar__77 <br /> C-i Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> o Q Inactive Q Truck I <br /> Longitude Q Planned Q OTR Q End Use Q Container <br /> II <br /> trr I <br /> Bustttess'Type (#il(all`that"apoly) ' <br /> -=--::: <br /> Q New Tire Dealer Q Auto Repair Q 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 /> PRC 42951 -Waste Tire Hauler Registration and Transport of Tires Notice Of Violation Extension <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> Q Q § 9 P iO Q <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 Q14 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 Q In Compliance - No Violations <br /> Q I Q Other: § <br /> Comments <br /> Inspection Form Included: Q <br /> Comments Include rt: Q ' 7 fir, f: <br /> it" thf <br /> Business Rep;;.Signature —- Phone Number IrSpe ,. �E .:. Phone Number <br /> INSTRUCTIONS ON BACK Correct: incorrect: X lip , 4 (� � 62081 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br /> m <br />
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