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10/11/2011 08: 15 2094615636 GOLDEN STJE LU-TER PAGE 02%02 <br /> c, <br /> 6BoAaA r, 5C1IW77 tof9oBf a � <br /> �� � $ jL.__._.i_n.s._.p,.ec—tion—Re.p.ort_Number.Waste Tire Survey.at Inspe � cr . <br /> Callforma (' r <br /> 101(Now 04104) ; - 11410:05s � ey � Rague <br /> Gnllfornla IntegrslQd Mate Manngontont Soerd 131.UEOR'.BLA& R- <br /> i J'P <br /> .E. <br /> 1\i <br /> Part,' $UrVQ N 7 x it pl 1^1� 6fSlIrSJ��d <br /> Y". r t yt,) �r ON <br /> ,�� r 1 v "r, .L.t`�'7 17. <br /> p Sy t <br /> 4Ytlltl � �ll �lu rJkl�El��� 'J 137 AZ3Rs Is,x r F .iGa. .r tiw:,'a �o-l.�:� ��'1��'.�':�1�kTt✓G- �, j r <br /> 1184a,a 4 a 7�1vON-GIR.5 S�'fPus <br /> -f Inspectlon Type (Fill one) <br /> 'Site Suffix: �� �1 ��- -� `-� �� �_ irk Routine Q Re-Inspection Q Referral ' O.ObServatiOn <br /> Local' G' if Referral,choose referral typo(Fill one) <br /> Identifier. ,A rl O Gl C .� n U t,; n�t' Q CHP Q.GIWMB Q'Compl73int Q Educational Visit' Q.other <br /> _ --. —. `: <br /> Business'-pr Facility Name :=;11nspeeted By Inspector <br /> I fL�cG_._..�..��c,�.���__._�-+.�.�.�:c1�1��'.rl n��I. -.� 1� `�.. - �. n � I � • <br /> IshysTcal•AI�r amass "t J <br /> Sti'Efl L � � Inspectlon Date. <br /> dL��U rtTime but <br /> I _. .-. _- _— _,.--.•. `_?;Tlf� Llf' 1prf 1 ,Time In -- AM 1— O nM <br /> Ci(y ^� — <br /> BuSicress Rep 7 Title t l ++�� l <br /> �'71J 1 O PM ct_ I . ^I PM <br /> _ 1 .,i �1 1�.(J..._ fl )............__.,..,,:,.....:.. :OPerational Stat SinAs ;. <br /> "(Fill onao-ly) } „I '(Fill al'tkiel aPpIY) <br /> Active �1 Generator , e r <br /> cSS.�!btW!.''a5'n.'.l°AEG <br /> Closed r I' <br /> .Q Hauler y , <br /> LatitudeL�._ - <br /> G�� EL J,!.- _�_.._. a •• Inactive tr <br /> ,O <br /> Longitude - ad Planned' t 7j r <br /> ' ' � � Y� q• r .riy '1.��il V <br /> E r'., <br /> �+� ✓•, (D'Dismantler- Q Tire Derived Fuel <br /> �00N-qaw,-rre'I�ealor: Q.nutolepair �`.Trucking•Fleet: '.Q.Govefir ent.•. O R7areddor <br /> Q lert'-. �,4`wtosB.G+d „—rr;,Q�aCawDe�lor-�•-�::r^r—O' <br /> Eo(fectiiy mb - -- :- -.- <br /> Q Shredder Q Other <br /> I <br /> 0,Service'Station Q Waulor Q Agriculture 7 <br /> ----....-- - —. .. i—. - .•• <br /> r nd�W'se' aCil <br /> Tare Q .Haul® � FlNfEf�lf`. 1ft.fi '' <br /> ins ection Baler Ger�arator, a.nd,B tY ' <br /> Part 8 p .of Waste , _ r;,:.:i•1;;.-,i::: ,•; _ <br /> "I'_'i-,�c'•i:: �?,,:rr>r,ir,4;;i'•h"� -;i:> �� 7.. ''fix � :i+i': •';ts,l,i' li,;�^ «o,K�y''+I <br /> r'^r:+,. " :f ,'.i" Li'.7 ••,'].,'4' ,.'r�r.l'�J..l. •14 La�r�y}yAG:�,�;�.g .r,.y i 17nr:.:i' <br /> A. <br /> y;jj'L •14�, '•. t,� lw�,ii'r.:'• 4 ::i ,:Wr,•, '.r c•. 1�$Itl, e Of Viclatlo$ l,�' i� T1;5+ <br /> .1'�`'/,�•irI•':� 't�:,. 1�4,Y�� ;:1,� .'1 L. )�� L_ - �y 1�•,•Fu�y.ia.:�i4ai,I is 1,.:.. <br /> i <br /> O rI PRC 42951 - osta Tire'H9uler.RPgistration an.d TransPortof•Tres. Y,�,..':f•rLr,ti1i;=�r-'•, i DiQ QPRC§42953-Contract„with Registered Waste Haulers.O ad”hnely,' <br /> O Q § s r tion/Oecal In Vehicle <br /> I PRO 42956-Rogi t 9 <br /> I In .with Manifesting Requirements <br /> 14,CCR§18459 :Responsible Entities.Comp y g <br /> O O O Q 14 CCR§ 18459.1 -Tire Program ID Nun6er from CIWMB P.rnaxv <br /> 4 r _ <br /> Logs withln 90 da s <br /> 9.2.1 -Submittal of Comprehive <br /> ons .Trip g Y "� o-->f7�� -.;�•', `:;., tutp•'+,.-�;.;,�+�;;;,c,+,?�`,��tls.:. ;. <br /> Q Q 14 CCR§ 1845 L ., ' •�::,;`'u;;;�-zy .+.-'>r''�L,'�::�,:�,v <br /> r },ui:,U K'vr'•Ytle,..:_:6h.ti'. <br /> 14 CCR§18859.3-Retention of Comprehensive Trip Logsfor <br /> Q O 3°years'' <br /> V 'srs; <br /> . ••• - ���?,fig&'err, ),`-'�N�Y(F8''�rti��E4rtra�nf'r;,rl<::;. <br /> 1 R •18460.2.-Msritfest System for RegisteredWaste TireHaulers••.. 1Yt ,., .•;.,: ,.'f..,.;„.�,;E�tffp��� 4rrr y' '`,{f's,'• <br /> Q (0 4.CC. § u...kt.'f:;;u. <br /> V1 �” " ri`�•�l 1 T �•�8:• !L.. ir11',�"lL�rd <br /> Iis+S: A r,i�.�t-�; �� '�l' "'1�� Aiwt°:;4 ••..-.., . <br /> 14 CCR§1'8481 -Manifest System Requirements for Waste Tire End-Use-Facitities is +,4; _s_ ,..wb'; ,�,..., �::•,:.: .:•; <br /> b <br /> .O t'r, •r'C <br /> O w.r• , k`�, ,-:•�si}d577:;tirtl'`I �i'ol•iL'i e,t,;f•'177 "�I!'�a^:'{'' <br /> eDealers.or;WasteT1re•.Generators• ��tr,<yf..iy' fl' <br /> . .§ •Manifest.aystem Requirement <br /> Tire. <br /> Q ;w 1.4 CCR18482 �l3ltt�i .moi?. Ne 1`!.,�,}.r;l,.,.t.•F, :..: I,,g. c;tv' <br /> OO Other, § _ ........._ _ ..,..,;,, ........ <br /> Comments ."'_' � e ;ti e r'��.11�.����•1�; 1'. 1 r r-1�..L::�1 <br /> �-, <br /> LLL <br /> n. <br /> .r rw!I•I• Y•1"`"y�yy, >^ t Y;13u1 r`�pr. � �.i�"��,�'�'t.I:Ur �r!ti I' 1/,•t,l;,7yr9dy ,. •if!' 'In'tJ' �r i� t ',' Nfl f,.= ,y,Pj�,�a ".�ur4�� � y f ; `+' <br /> •�L�iV,'.,.,ty� "^W.: ,i + R 8P pp I J•FY,ut, l i ,7 M �,I 1Y 'F,��ii F'�i Y'.� ,.1 1 ..� �,v4 n ! I, ,r IStd :"���i ii{ Ilnrl I i' ,r� ' N �`�•.i'•.I,�7 <br /> ,Ir,i:t��p r ��rI11�Q1vpr L1 �(yyy��1 Y ,'!t � ,.�i q li I,M$ �1d'p r'�"'; ' r9 1 p�.11! r i IN's� i R �)� �1�,.�'L•,k"'. 6,U y, q 1 �' �1 ti` 'V �, �/' �,ii <br /> 211+ � Il•� 'Alfl"L'� 4,w� V elf �.�.:01y `ii �'9 l,� .1�5!Ih t,' w�:� J, r{lt i ,P ��.� '-'v;. I i 1�r1r � A .t`/ l�• ,��!„t L'ru,(::n <br /> �._I.F ik'"oeN'Cc+,�UJAYl d r`<:,.t�Idi,atiF1l4t;tE <br /> "y_'•3�r�r{�I p r�ry•"�,6I���lGIL)a i"•'Icl' .Me1 <br /> � <br /> �yGy8irf2Lt®y08yR,�1 <br /> _dr_; ✓r <br /> ,fr <br /> ,._�- ,..,' ,;l,:r•.,,r,�,.,.r.c:;ur•iayfr.;- n• <br /> INSTRUCTIONS ON BAC'14 r� .t.; ;ssa .: '.5 ( = •ur,: 1?r... <br /> tYellow CgPY.OpoMtor PIN(Co*LEA. <br /> v:: Received Time Oct. 11, 2011W 8. 02AVAIE. 2365 <br />