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TRA-KDMI3SION VERIFICATION REPORT
<br /> TIME 02/18/2009 15:27
<br /> NAME SJC ENV HEALTH DEPT
<br /> FAX 2094688392
<br /> TEL
<br /> SER.# BROM7J748813
<br /> DATE,TIME 02/18 15:24
<br /> FAX NO. /NAME 919163197365
<br /> DURATION 00:03:00
<br /> PAGE(S) 04
<br /> RESULT OK
<br /> MODE STANDARD
<br /> ECM
<br /> •` ''ii�'� V �. C�.' 1' ( �Iftpe,dian.'RbporUN. ,V' mber�.
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<br /> 5tata Of Cnlll�rimla QQ �c /� !�1 s� 1 //y
<br /> C4WM9.189(NOW.0416AL. :'tiJU rr �orm- ', �.1 'L
<br /> GalRornlb jnt64iAtad Waste MAnagamenF86Md Y •.
<br /> aft-A�.Suive` B UFQR•BLACK'INK.-PEN
<br /> TPID- j /'� j� _ Inspection Type (AHI one)
<br /> Site Suf€ix: ! W `T J r Q Routine. Q Re-inspection Referral a Obseniatinn
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<br /> Local If Referral,,chbbse rq%irattype'(Fill bne)
<br /> identifier: (�t,� � , Gil (ft,�y,_ (j•tit,Y�'1 ( CHP GIWMB Q Complaint 0 Educational Visit Other
<br /> Business or FacllltyNernp Inspected Ry Inspeatar
<br /> ysi• Ad re5s 1 L..:.;:..1� r' I �..._—��.,_.1.,.. f .�:�' i
<br /> :,trwet :•,I lnspecti6n Date'
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<br /> Co-C "Time In Time'Out
<br /> i rfy Q AM O A(�+l
<br /> Businoss Rep Title - PM U PM
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<br /> �-----��- .operational Status Business Rple' '
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<br /> lr (Fill one only) (Fill all that Apply)
<br /> ✓r ( Active ((�Generi+tor .
<br /> - _..
<br /> Io Q Closed
<br /> Latitude
<br /> GPI 0 Inactive;Ld 1�,'Hauler
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<br /> �_.....,.....' .�'•�r1d-Use
<br /> Longitude - i O Planried
<br /> Manx, u
<br /> I -
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<br /> ( a
<br /> Q:New Tire oealer Auto Repair C) Trucking Fieet 0 Government (D Retreader Dismanfier { Tire Derived Fuel
<br /> 0.Llsed Tire Dealer b-Ruta 8a* 0 Car Dealer Collection Q'Crumb Rubber ;
<br /> Serviger
<br /> •Station• Hauler d Agriculture O'Shreddet 0 Other, - t.
<br /> y—'_ to Vire Dealer Generator Hauler and Fn&V. .Facility
<br /> Part.9 Inspectioii of Was
<br /> �.:, ' .
<br /> m'^�' -- -'-?T.,.•^-:...:;,.,,,.— �,;.�,,,,r.:;-",".,- y.,Fr. *,�, �� ,tir,1�cl.�,Y��!!'�;:;i''r•,;..:i'.'d3
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<br /> • � C§42951 -Wa'stfs.Tire Hauler Registration and Transport;pf Tires'1.
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<br /> (� . •PRC'.§47.953:Contracts with:Registered 1Naste Tiro.Hauiets.
<br /> a :,( PRC§'42958 RegislrationlDecal in Vehi41
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