|
Waste Tire960y & Inspection Repdft inspection Report Number ■
<br /> Cate
<br /> MB 81California
<br /> (New 04/ 4Survey Form - Page 1 0 - 10 13 1 2_
<br /> california Integrated Waste Management Board
<br /> Part A Suryey BLUE OR BLACK INK PEN
<br /> Bus ,
<br /> TPID- /' J Inspection Type (Fill one)
<br /> f Site Suffix: `� �� f ` (0. Routine Q Re-inspection Q Referral Q Observation
<br /> Local `' If Referral,choose referral type(Fill one)
<br /> Identifier: Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other
<br /> Business or Facility Name Inspected By Inspector
<br /> Physical AddressI — OA
<br /> r �'_/� o ;/Y.,
<br /> Street
<br /> Inspection DateED
<br /> (itv State ZIP Code Time In Time Out
<br /> Business Rep Title 11 AM 0 AM
<br /> [--F
<br /> �1 0 PM L� ' 0 PM
<br /> Lt,z
<br /> Operational Status e ,� ""�1Z Business Role �,rs
<br /> (Fill one only) �rN1t; Py� (Fill all that apply) ) I �r
<br /> W".
<br /> �„ rsS�v ,,,t tm�'Ms,mt"�,� �� "�✓t'
<br /> Q Active Ql ) Q Generator
<br /> r
<br /> O Closed
<br /> Latitude Q Hauler
<br /> ' Q Inactive Nr ✓ a a" '� 4 r ��
<br /> _ y �d����f���
<br /> Longitude — Q Planned I �fD �ia"✓�ti Q End Use � 0�"
<br /> -, „x.,,."P., 'v e•fs v,x: a r'+ t;"+p � u! ;„�,y�,�� , r '�FYr':y Y 1 `"r1�'�„r�.5, ”' , .�" 4 Cr A;: F 4 ..,fi>r Y,,Y�+7�✓°�,i°r'"°a9�rG� .�'
<br /> ",,:. i „ k ;c ,� .,er(i ,,+' y�n k 3", ,:"� 6 r.1,,,,w� a tu',..::, ," ,,.:,,ar; / w a A nh..!1✓+ r,, r" 7„+T..
<br /> �r�� � ,, �) � i ^” ,��aw_1 .�u�c .w_..a�"rS„z”Ott?,.��p:�,.��'.����k"":��Ervr,i"",�'�x��.j`1.•", ���¢G�f NiM'Wtg„..�...!�.��—../4r"t�+•1i�.y���,��^�G.L.��
<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 /> A HAULING AND MANIFEST REQUIREMENTS
<br /> V Q Notice Of Violation Q Extension
<br /> Q ' 0 § g p
<br /> PRC 42951 -Waste Tire Hauler Registration and Transport of Tires li
<br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. I Compliance Deadline
<br /> PRC§42956-Registration/Decal in Vehicle
<br /> Q Q 14 CCR§ 18459 -Responsible Entities Complying with Manifesting Requirements Date
<br /> Q Q
<br /> 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB m m m
<br /> 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days (Required for NOV or EXT)
<br /> Q Q 14 CCR§18459.3-Retention of Manifest Forms and Tire 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 § -Manifest 14 CCR 18462 Sy q stem Requirements for Tire Dealers or Waste Tire Generators
<br /> ( In Compliance - No Violations
<br /> Q O Other: §
<br /> CommentsJ '�l f�'� L
<br /> Mr, r' ;'�'�>Er,.�Fj �..,. f C:'_ T _j•: f-7�l r�f ;�E�':-..-�? + j,. ^.f1 G` j '_
<br /> 6 A
<br /> - 62081
<br /> INSTRUCTIONS ON BACK ' 'M � 'L
<br /> �
<br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA
<br />
|