Laserfiche WebLink
0925904.4S96 <br /> z Fay. Waste Tire Su ;y & Inspection Repor 1! Inspection Report Number. <br /> State California Survey Form - Page 1 11 - 1141172 <br /> CrWMB181 /04) � . <br /> califomia Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- -gir,, _ Inspection Type (Fill one) <br /> Site Suffix: d/�1 V 0 Routine - Q Re-inspection Q Referral I l �VI 3 Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: L-- O Q CHP Q CIWMB Q Complaint Q Educational Visit .Q Other <br /> Business or Facility Name — <br /> �� C0 A4b t Inspected By Inspector <br /> Physical Address ` � SFC <br /> l—�_p5��_W• _5 'IJInT.C�.T —Mh1 i <br /> Street / / O <br /> Cityc a G Q5 Inspection Date I I� 191 <br /> A Stare Z�Code Time In Time Out <br /> Business Rep Title L� 0 AM 0 AM0PMFlo GPM <br /> yOperational Status Tire Type Business Role Storage-Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) .(Fill all that apply) <br /> Tire Count (Whole/PTE) <br /> I&Active Passenger ® Generator O Outdoor <br /> - -- I�--�-- ll �� �- �-- -�--�- --=O Q Closed Q Altered <br /> GPS Latitude - I I . i j j I Q Hauler ® indoor <br /> J�1—i0 Q Inactive Q Truck <br /> Longitude Q Planned Q OTR Q End-Use Q Container <br /> Business Type (Fill all that'apply) <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 /� 1 <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other <br /> -- -- L <br /> Part B - Inspection of Waste Tire Dealer, Generator; Hauler and End-Use Facility ENFORCEMENT STATUS �:��� w� <br /> VA�.§aHAULINGANDMANIF,ESTE,REQUIREMENTS�� � $ <br /> Q Notice Of,Violation ,,Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> " , <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. -Compliance DeadUne : <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q O 14 CCR§ 18459 -Responsible Entities Complying with Manifesting Requirements <br /> Q Q 14 CCR§ 18459.1 -Tire Program ID Number from CIWMB ,e ,2; <br /> k41 RsdrorN " aXTQQ14 CCR 18459.2.1 -Submittal of Comprehensive TriP Lo s within 90 daysequeOVr t) " <br /> Aa � <br /> 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 �QReferrel CIWMB�Enforceriientlu <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 "- <br /> �In Compllance No`;sViolations <br /> Q Q Other: § <br /> Comments -1- t — a� -Q' ���OWI <br /> f. <br /> _Ak�o%70 <br /> Inspection Form Included- <br /> Comments Included: ——— — v- <br /> Business Rep's Sign ture Phone Number Ins or's Si nature Phone Number <br /> P g <br /> 62081 <br /> INSTRUCTIONS ON BACK Corr ct: nt f j�Y ��X A MIP <br /> L 1 2 3 <br /> White Copy: Yellow Copy:Operator Pink Copy:LEA <br />