Laserfiche WebLink
09210040501 <br /> 'nee <br /> Waste Tire Survey & Inspection Report Inspection Report Number_ <br /> °' slate B91(Now <br /> NCalifornia I 1 — 1108470 <br /> Cgrated Waste <br /> eManag) Survey Form - Page 1 __ � <br /> California Integrated Waste Management Boats <br /> Part A- SurveyBLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: y 6 i 6 .� Ip� I D—� ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local / If Referral,choose referral type(Fill one) <br /> Identifier: C�m-#-r ,J 0 CHP . 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> P ysQq• d Street <br /> I, /'� Inspection Date I ' , R I () C/ i <br /> L_t-r_ene.l__&Y4P Q5o13)- Time In �j Time Out <br /> — L <br /> City State !L Cor• __ _ _ <br /> Business Rep Title j /� I Q AM ;-� Q AM <br /> ,set Axe <br /> 4D PM <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 Generator <br /> ® 0 g ® ®Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> 0 Inactive 0 Truck <br /> Longitude - I Q Planned OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> ,L- 1 <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder ®Other f�,VU .1 _ i�� �P <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V'- 'A .HAU,LINGA,,NU,MA.NIFEST REQUIREMEN�TS� ' ,y ', <br /> Q Notice Of 1/iolation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers" Compliance Deadline <br /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m <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 ("ey i d for NOV or DC7) <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 I CIWMB E forcement <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 ®In Compliance No V1 latio s <br /> 0 1 0 1 Other: § <br /> _.a <br /> Comments 1�` ,� 7-e' A <br /> In Y20 Jrc� <br /> Inspection Form Included: 0 4 <br /> Comments Included- 0 <br /> Busfes Rep's ignatureZ Phone Number Insp ct s Snat re Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Co eet: correct: X A M P E. 1 .2 3 <br /> White Cop ..CI Yellow Copy:Operator Pink Copy:LEA <br />