Laserfiche WebLink
Waste Tire Sul, y & Inspection Report ispection Repoit Number <br /> State CIWMB California I 1 - 114 0 9 8 5 <br /> grated Waste <br /> eManag) Survey Form - Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection© Inspection Type (Fill one) <br /> Site Suffix: Z g b r 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: SZµ, - R5!gi,41 ry 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name �+��1 <br /> Inspected By Inspector <br /> Physical Addr !� �ePa f 3 - 0 1 �YKa go fi � <br /> o? <br /> 5-60o S. <br /> Inspection Date ` 0 / 0 <br /> / <a `y CA- (?S- Time In Time Out <br /> Business Rep Title �ry O AM 0 AM <br /> V ® PM e ® PM <br /> I`GdCOCytJY.0-Q - r0. �'lDjCGfl��^' Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) ( only) ( apply) ( apply) ( 1 <br /> apply) <br /> 8 Active 0 Passenger 0 Generator0Outdoorr <br /> O 0 Closed 0 Altered <br /> _ -GpS Latitude — - -— tauter - - <br /> 0 0 Inactive 0 Truck <br /> Longitude - 0 Planned O OTR 0 End-Use ® Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet • Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other <br /> Part B-Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> -—---- li 0 Notice Of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <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 / m 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 /> 0 0 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 In Compliance - No Violations <br /> 1010 Other: § <br /> Comments r <br /> -- M 4 km7 =. C►'I�ff.�-r`CAti+ c7y� �1� �f�1.+ �:1M� 4��J-rte`[ f <br /> Inspection Form Included: 0 <br /> Comments Included: 0 <br /> Business Rep's Signature Phone tuber spector's Signatu Phone Number <br /> - - - - - - -- - - - - - <br /> INSTRUCTIONS ON BACK Correct Incorrect XAt P 62081 <br /> rq I <br /> V� 116 Y:IIoA _L�y. Pink C y: <br /> irk. <br />