Laserfiche WebLink
08129040729 <br /> crr_ <br /> Waste Tire Survey & Inspection .Report Inspection Report Number <br /> State er Calirornia <br /> CrWMB 181(NaSurveyForm - Page <br /> 1 - 1 0 7 2 8 0 2 <br /> w 84/01) <br /> California Integrated Waste Management Board <br /> Part A-Surve BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPIO- q Inspection Type(Fill one) <br /> Suffix:Site f ( TJ ` 0 Routine O Reinspection Q Referral Q Observation <br /> Local If Referral;choose referral type(Fill one) <br /> Identifier: I son TOG Ct AkR C,O Argy Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> I 12 A�_p�'l5 C7 fQCe,('y I �j _ <br /> Physical Address <br /> J• 3 \ 0 i }((t5'�-ictn LtAcaS I <br /> free Inspection Date <br /> �S�c�ckton G_Pt g5zo6_j <br /> City State ZIP Code Time In Time Out <br /> Business Rep Title O AM O AM <br /> 0PM m'm OPM <br /> I IOperational Status The Type Business Role Storage Type: <br /> Tire Count(Whole/PTE) { ! (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> r I O Active Q Passenger Q Generator O Outdoor <br /> 0 0 Closed Q Altered <br /> GPS Latitude I I J f 1 I—�—1 - Q Hauler Q Indoor <br /> — l_J— l O 0 Inactive Q Truck�1/ wA A(A <br /> Longitude O Planned Q OTR 7A Q End-Use Q Container. <br /> Business Type (Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet O Government Q.Retreader 0 Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer O Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler O Agriculture Q Shredder 0 Other <br /> Part B-Ins Inspection of Waste Tire Dealer,Generator,Hauler and End-Use Facility ENFORCEMEN <br /> __. T SiTATUS <br /> P Y --.-.-_----.-_--_----___--- _ <br /> y A HAULING AN_MANIFEST REQUIREMENTS Q Notice Of Violation Q Extension <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport of Tires <br /> 0 Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance 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 EX7) <br /> O 014 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> O O 14 CCR§184602-Manifest System Requirements for Registered Waste Tire Haulers Q Referred I -1 MB Enforcement <br /> O O 14 CCR§18461-Manifest System Requirements for Waste Tire End-Use Facilities _ <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance - No Violations <br /> 1010 1 Other: § <br /> Comments RCluttt�e.. � e�io��_c�c�cme.d his d4-i� � -t�1a�o1_�s►s�?i��wLos—tto�sd� <br /> Fact\',k.l .s Ino \o S \,x )a %ae5s k does ncrl _YIz -_o1441AY5 Cullclress - -T `1_ <br /> 1 sai=tcs r_"Wrermu -112 prernzsisDr t52GL13R– C51_T_1IJo 41.Le� <br /> _a1�s ry rt ss w1� y i olo.'ki o ns or '&C:2. 1n o1 t3 ea . ,s Hess R� rn _ <br /> Inspection Form Included: <br /> Comments Included:Q — — 4 <br /> 0-3178 <br /> Business Rep's Signature Phone Number In s Signature Phone Number <br /> INSTRUCTIONS ON.BACK Correct: Incorrect: ( AMP — 62081 <br /> ■ While Copy.CIWMB Yellow Copy Operator Pink Copy LEA ® ■ <br />