Laserfiche WebLink
10328050001 <br /> � Jnr <br /> Waste Tire: Survey & Inspection Report Inspection Report Number ■ <br /> State of California - <br /> Cgrated 1 teManage Survey Form - Pagel - I1 - 11-409,q?- <br /> Part <br /> Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- q Inspection Type (Fill one) <br /> Site Suffix: Ft <br /> 53- <br /> 5 3 i 3 ( — ® 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 <br /> Inspected By Inspector <br /> Physical Address <br /> - <br /> Street <br /> Inspection Date <br /> 1.- -�� Z�(,-jTime In l Time Out <br /> City State ZIP Code <br /> Business Rep Title � i , =1 <br /> 0 AM <br /> 0 AM <br /> PM Inj <br /> 3jJ ® PM <br /> A6 -- <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 /> I 13 9 Active ®Passenger Generator ®Outdoor <br /> Latitude D Q Closed Altered <br /> GPS <br /> Q Hauler indoor, <br /> ( � <br /> O Inactive ®.Truck <br /> Longitude - I I .I I I I Q Planned Q OTR Q End-Use Q Container <br /> Business Type (Fill ail that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader ®Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body 0 Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q Other i <br /> Part B -Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT S1TA�TLUS <br /> V A HAULING ANP)MANIFEST REQUIREMENTS <br /> O O ® Notice.of Violation Q Extension <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date ! , 0 M O 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> O O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Beguiled for NOV or IX7) - <br /> Q O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CIWMBa,Enforcement <br /> yr <br /> Q O 14 CCR§18461 - Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q O 14 CCR§ 18462- Manifest System Requirements for Tire Dealers or Waste Tire Generators O In Compliance - No Violations <br /> 11111111111111111111111 <br /> Q Q Other: § <br /> Comments <br /> ��-ll�-i� G✓li S—hakcQ:_ <br /> Inspection Form Included: Q <br /> Comments Included: ® 6 2- <br /> Business Rep's.SI nature. Phone Number Inspector's Signature Phone.Number. <br /> INSTRUCTIONS ON BACK Corr c Inc,orrect: E�X AIJ►h P L I 3 62081 <br /> While Copy.Cl 8 Yellow Copy:Operator Pink Copy:LEA ■ <br />