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Inspection Report Number <br /> Waste Tire Sudky & Inspection Repori <br /> State B California I 1 1088134 <br /> Cgrated asteManage Survey Form - Page 1 <br /> California Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> spection Details <br /> TPID- Q T� � �El <br /> Inspection Type (Fill one) <br /> Site Suffix: I II�� O 5 9Q Routine Q Re-inspection Q Referral Q Observation <br /> Local I -r If Referral,choose referral type(Fill one) <br /> Identifier: San TO C1lal n O ct11�� Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> 1 -7homa� TrU(_k1y)Q .Tnc <br /> Physical Address j 0I 1/4 I�-�( �y� <br /> i 19555 N. h\ghwntj g t <br /> Street Q <br /> Inspection Date Q <br /> 1 Acarnpo CA 952zdl lee-goCity State ZIP Code Time In Time Out <br /> Business Rep Title OAM O AM <br /> VI(_e <br /> I i ' 0P ET 0P <br /> Al UU. Thomas „ presAd.e nA I . <br /> Operational Status Tire Type Business Role Storage Type <br /> .Z q (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) <br /> ® Active Q Passenger (S Generator Q Outdoor <br /> 0 Q Closed Q Altered <br /> Latitude . <br /> GPS Q Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - I Q Planned Q OTR Q End-Use Q Container <br /> � Business.Type (Fill all t Applyp , <br /> Q New Tire Dealer Q Auto Repair ® 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 Q Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS Q Notice Of Violation Q Extension <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 Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m / m m <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 EXT) <br /> Q Q 1 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 1 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 Q Other: § _ _I <br /> Comments <br /> Rautlr1e tInsp CAton f!))Xc1 -th L-, clC&E i-1 ll_0 t AJiL`_j �_JC�_ n area <br /> Faces uses both bo_e� Schwab UOlik or) latah -Tire C-o �Gir Ire --e,17-VI-CAL <br /> � wa�t� fire {emaval 5 res� ct►v�l,� P'�ost tyre <�erv>,ce. ,s 1v.er�tar►�.cl o� �It-e. <br /> I C L, UA ,on woo -Tirc co . wt)i\ IAcx,x� w_ft2t-e_ <br /> Inspection Form Included / <br /> Li <br /> Comments Included. _ n <br /> �� /7G <br /> _? <br /> Business Rep's Signature Phone Number pector's Signatu f Phone Number <br /> / 62081 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X '� V E ; l M i i 11 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />