Laserfiche WebLink
F. 092100SO017 <br /> Lig Waste Tire Survey & Inspection Report Inspection Report Number <br /> "s I1 - 10869247] . <br /> i� State of California <br /> Cgrated t(New nage) Survey Form- Page 1 . <br /> California Integrated Waste Management Board <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type (Fill one) <br /> Site Suffix: t y t 1 3 l 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local 1 � If Referral,choose referral type(Fill one) <br /> Identifier: . w' V Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address i <br /> L2Qo2.O _jle�Citf�'�nvY ' <br /> Street <br /> Inspection Date <br /> y State ZIP Cods 6-1Inspection <br /> In Time Out <br /> City <br /> Business Rep Title �� , O AM I —� Q AM <br /> 16 PM U� C �� Ip PM <br /> Operational Status Tire 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 /> t Q Active Q Passenger 0 Generator Q Outdoor <br /> O 0 Closed Q Altered <br /> GPS Latitude -,- - Q Hauler ® Indoor <br /> O Q Inactive Q Truck <br /> Longitude - i , ; Q Planned 0 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 Lr r K <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility I ENFORCEMENT STATUS _ <br /> VI='M&L!ING M 51 M A:N I F.E SMj _ITISiiiiiiiiiiiiiiii <br /> 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 <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 <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 C•IWMB 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 0 In C-ompllance - No Vio a ions <br /> Q 1 Q 1 Other: § <br /> Comments <br /> weeCe-r�me� <br /> Inspection Form Included: Q <br /> Comments Included: 0 — q69- 6.7 <br /> Business Rep's SigrRt.ure i Phone Number In eco S' ure Phone Number <br /> INSTRUCTIONS ON BACK Co act: eorrect: 62081 <br /> EXAMPLE x `23 <br /> White Cop Yellow Copy.Operator Pink Copy.LEA <br />