Laserfiche WebLink
07313340s34 <br /> Waste Tire-•Survey.& Inspection Report Inspection Report Number <br /> c1WM f181(New Survey. Form Pagel 11 - 1 0 7 3 4 6 6B 181 stew nage <br /> Cellfomla Integrated Waste Management Board Si <br /> my <br /> Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: . b_L3 • 'T _? q I / o Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: -�,�Q„t � 0 CHP 0 CIWMB 0 Complaint .0 Educational Visit 0 Other <br /> Business or Facility Name 9 Inspected By Inspector <br /> L—�I 1► �— ��ota_�..,nc_. � <br /> Physical Address v 3 O <br /> m - � a �,� <br /> rsl`rear o?o_��� S_Mt�c_!qr- ±r �• <br /> _ Inspection DateCA <br /> I r4C�1y/ Time In Time Out T <br /> City Q State 'IZIP-53ode J <br /> Businesss�Rep. �f Title 0 AM 0 AM <br /> I Girl LH-. G� n O'WWPX I m•m®PM LD m ®PM <br /> Operational Status Tire Type Bustness Role >Storage Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE)1 1 <br /> lI <br /> ®Active 0 Passenger 0 Generator 0 Outdoor <br /> 1 I O 0 Closed 0 Altered <br /> GPS Latitude I � r: Q Hauler, ®Indoor <br /> W O 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair a Trucking Fleet 0 Government 0 Retreader 0 Dismanfler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body- 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other I <br /> Part B-Inspection of Waste Tire Dealer,Generator,Hauler and End-Use FacilityENyORCEMENT STglT11 <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation <br /> 0 0 0 Extension <br /> PRC§42951-Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 0 0 PRC§42956-RegistrationlDecal in Vehicle <br /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements <br /> 0 0 14 CCR§18459.1-Tire Program ID Number from CIWMB <br /> 0 0 14 CCR§18459.2.1-Submittal of Comprehensive Trip Logs within 90 days (Requi ed for NOV or FXT) <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred t CIWMB Enforcement <br /> 0 0 14 CCR§18461-Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance - No Violations <br /> 0 1 0 1 Other: § <br /> Comments <br /> --L, <br /> - t>GS—rYS 1'7�' <br /> r+eln�Y r—�i.e4 LTUVet,..e�l_ re erE• 1trn� )%A&K *3)zc db4e4N__d <br /> k-�r-.. <<�S CQn�.vt cs�lel o�+3aln.w tcc�-•---(���Lo_�� cf►�C <br /> Inspection Form. Included:0 <br /> Comments Included:0 <br /> Business Rep s Signature Phone Number `'"inspector's Signature- Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct: Incorreete E X A hh P E 1- 2 3 <br /> ■ White Copy CIWMB Yellow Copy:Operator Pink Copy LEA ® ■ <br />