Laserfiche WebLink
Waste Tire Sui - 43y & Inspection Report inspection Report Number . <br /> CIWMB 81California <br /> Form - Pa e 1 I 1 1143653 <br /> California Integrated Waste Management Board <br /> Part A_-Survey _ BLUE OR BLACK INK PEN <br /> Business Profile inspection Details <br /> TPID � O � � � � � - h � Inspection Type (Fill one) <br /> Site Suffix: v 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local 1 If Referral,choose referral type(Fill one) <br /> Identifier: � n{ Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name lJ 1� Inspected By Inspector <br /> • o_ npA Sten �1 fc - <br /> Physical Address 31 I V n <br /> I &-n E$COA10 <br /> n OS�� Inspection Date 0 <br /> A <br /> l Time In Time Out <br /> Business Rep Title 0 AM 0 AM <br /> �- 0 PM 0 PM <br /> Q (�(Nt s �r1w —Son OAA p-r -- - - -- - - -- <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 /> Q Active Q Pass��e] Q Haunng�er Q Generator Q Outdoor <br /> r�Y <br /> GPS Latitude <br /> - - _ - - - - -- O 9 Closed Q AlteA � /ler`r//� or"/� <br /> Q Indo <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR 0 End-Use Q Container <br /> Business Type (Fill all that apply) <br /> (a New Tire Dealer ® Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> ® 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 j 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 <br /> Date <br /> M / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> Q 0 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 /> i <br /> Q 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 1 Q Referred/CIWMB Enforcement <br /> Q 0 ' 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 /> Q Q Other: §•�1 1 _ M- <br /> Comments lj��� � ��� \�` v — (�f l!-Ifs/- �YLL Ci - <br /> -vt <br /> ,Inspection Form Included: Q' <br /> Comments Included: - <br /> Bsines Rep's Signature Phone Numbers Inspe is Signature hone Number <br /> INSTRUCTIONS O BACK ! Correct: Incorrect: ; I A E 1 2 3 62081 <br /> ■ White Copy:CIWMB Yeelllow -- — - - f ■ <br /> Copy:Operator Pink Copy:LEA <br />