Laserfiche WebLink
Waste Tire S14y & Inspection Repoi 'Inspection Report Number ■ <br /> =»_= State CIWMB California I 1 - 114 3 5 4 5 <br /> grated Waste <br /> eManag) Survey Form - Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey- -_ - - - BLUE OR BLACK INK PEN <br /> Business Profile inspection Details <br /> - - - - -- - - <br /> TPID- Inspection Type (Fill one) <br /> L� �Site Suffix: �`� l 6 6 _ © -1 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Localil 1 r� 0 ch If Referral,choose referral type(Fill one) <br /> Identifier: ►' l �-(✓ 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical'Addy ss , 3 �1 - © I TTF✓((OU <br /> l ---- <br /> � <br /> q� Inspection Date -70 -7 <br /> ,r� <br /> " ' " a36 Time In Time Out <br /> Business Rep Title 0 AM0 AM <br /> ' ® PM C,L Z_`5 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 /> f 0 Active 0 Passenger Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler ® Indoor <br /> p Q Inactive ® Truck <br /> Longitude - 0 Planned OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair ® 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 /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder Other <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A 1 HAULING AND MANIFEST REQUIREMENTS 0 Notice Of Violation 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 / m / m <br /> 0 0 114 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 (Required for NOV or EXT) <br /> 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/CIWMB Enforcement <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 0 In Compliance - No Violations <br /> 0 0 Other: § — --. <br /> Comments <br /> ), <br /> IInspection <br /> omme is Included: 0' ff7 r�c/ D_7� Yu�� <br /> C ®i usine s Rep's Signatt Phone Number peis gn lure Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: i X A <br /> .. 62081 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Cop :L <br />