Laserfiche WebLink
Waste Tireouioy & Inspection Relorto Inspection Report Number <br /> _�- State I3 California I 1 - 1141336 <br /> Cgrated Waste <br /> eManage) Survey Form - Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey– _ BLUE OR BLACK INK PEN <br /> Business Profile I Inspection Details <br /> TPID- r Inspection Type (Fill one) <br /> Site Suffix: l 3 J - <br /> i 9 Routine Q Re-inspection Q Referral Q Observation <br /> Local U /r, If Referral,choose referral type(Fill one) <br /> Identifier: CJv Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> n'lCOCCa <br /> �� I`�ec�bc�� �e��o✓l� <br /> Physics Address <br /> ^�� Inspection Date % r� l OCrk C� <br /> ul Time In ( Time Out <br /> Business Rep TitleO AM Q AM <br /> ' � O� �� ® PM e, � �PM <br /> E ► YYiS L <br /> fie c�c�nlcJ <br /> - - - -- Operational Status Tire Type Business RolleStorage Type <br /> Tire Count (Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) <br /> (Fill all that apply) <br /> ® Active le Passenger 9 Generator A Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive Q Truck I <br /> Longitude - Q Planned Q OTR O 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 <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A I HAULING AND MANIFEST REQUIREMENTS Q Notice Of Violation Q Extension <br /> _ -- — __ <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts-with Registered Waste Tire Haulers. Compliance Deadline <br /> Q O PRC§42956-Registration/Decal in Vehicle <br /> Q O 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CIWMB <br /> Q O 14 CCR§ 18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> Q O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> I <br /> Q O 14 CCR§ 18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred 1 CIWMB Enforcement <br /> Q O 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities - <br /> O 1 O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®in Compliance - No Violations <br /> O O Other: - <br /> Comments I_VLI��o lfc_� _1 <br /> )T„ �t ►"1_� _ (a -- is C CI,_ <br /> -tel <br /> Inspection Form Included: Q <br /> Comments Included: Bushe Phon umber In a or's 1 ature � _ one Number <br /> `'GAO a 7 <br /> o <br /> �- <br /> � 62081 - - <br /> INSTRUCTIONS ON BACK =�C P' L Y . <br /> n <br /> . ._ , <br /> White Copy CI Yellow Copy:Operator Pink Copy:LEN <br />