Laserfiche WebLink
091 $204t320� <br /> ==4e_ Waste Tire Su -y & Inspection Repor Inspection Report NumberState of _ <br /> CalifomaintefWMe 81steManage SurveyForm - Page 1 I1 - 1108447 <br /> integrated Waste Management Board "J' <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- i r i 1 I Inspection Type (Fill one) <br /> Site Suffix: 41 Routine Q Re-inspection Q Referral Q Observation <br /> Local Ii If Referral,choose referral type(Fill one) <br /> Identifier: ( rnyl� l Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name V <br /> Inspected B <br /> P Y Inspector <br /> Ph sica dress13UL -J, L/& <br /> Inspection Date I / L L 6X <br /> I / O <br /> C„y �r,�; LI” aCs Time In Time Out _ <br /> Business Rep Title ;-�—i i -- —I AM - - i 2 1 Q AM <br /> ' Iv QPM i3 i •. LJ � 0PM <br /> Aova C- DS 5 -- �r�t fin. -- - ---- --- - -- -— - --- <br /> Operational Status Tire Type Business Role Storage Type <br /> f (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) <br /> f ®Active Q Passenger ®Generator Q Outdoor <br /> 0 Q Closed Q Altered <br /> GPS Latitude � Q Hauler ® Indoor <br /> _ O Q Inactive O Truck <br /> Longitude - Q Planned ® 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 <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other L_�Y1]G.CI.—_ <br /> Part B - Inspection of Waste Tire Dealer,'Generator, Hauler and End-Use Facility ENFORCEMENT STATUS _ <br /> V A HAULING AND MANIFEST REQUIREMotic <br /> ENTS <br /> Q Q Q Ne Of Violation Q Extension <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. C-ompliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or FXT) <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CIWMB Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities _ <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance - No Violations <br /> Q J Q 1 Other: § - <br /> - — <br /> Comments n 1-h0ef I MJ <br /> � �bIQ AIrl cam-- <br /> Inspection Form Included: Q <br /> 209-s8i-9� a `r68-l6 <br /> Comments Included: Q - �- <br /> usiness R p;pAgn Is Sat Phone Number <br /> INSTRUCTIONS ON BACK orrect: In rrect: X IL A4 P .L111273 62081 <br /> Whi Copy:CIW Yellow Copy.Operator Pink Copy.LEA <br />