Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number ■ <br /> State CIWMB California I 1 - 114 3 5 7 4 <br /> graed 1 Waste <br /> Survey Form - Page 1 <br /> California Integrated Waste Management Board - <br /> `rt A- Survey BLUE OR BLACK INK PEN <br /> Iness Profile Inspection Details <br /> I PID- l � � � e � I Inspection Type (Fill one) <br /> Site Suffix: 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier. Suo J Q(QG>�1 f� �'lk f1�1� 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name J Inspected B <br /> p Y Inspector <br /> We,sA cLclovos�n l O J <br /> Physical Address 3 1Q <br /> Seo(,k-6t CA 15),03 Inspection Date / / I D <br /> Time In Time Out <br /> Business Rep Title t 0 AM 10 AM <br /> t 3 0 O PM I 5 O QPM <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 /> 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> - — — - - - <br /> Latitude ----0 0 Closed 0 Altered AN <br /> GPS (3 <br /> O 0 Inactive 0 Truck /A 0 Hauler 0 Indoor <br /> Longitude — 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <br /> New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 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 woacLus <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A I HAULING AND MANIFEST REQUIREMENTS <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires 0 Notice Of Violation 0 Extension <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 (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 <br /> In Compliance - No Violations <br /> 0 0 (Other: § <br /> Comments "r t�� I t F I t <br /> 1�I ►a �c,-A".0 ►S d '� nc � o_��nun n -wc,:s n- c� - <br /> k` <br /> �1..spection Form Included: 0 49-317.0 <br /> ��� I <br /> Comments Included: 0 ---- ---- --- �v I 3 /p <br /> Business Rep's Signature Phone Number Inspe or's Signature Phone Number <br /> - — — . -- - — - -- <br /> INSTRUCTIONS ON BACK Correct:* incorrect_ X( A MIP �, � �� ' � 3 62081 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />