Laserfiche WebLink
07312040372 <br /> Waste Tire Survey & Inspection Report -- Inspection.Report Number <br /> ■ ,'•,r State of California I i O10-8 V <br /> ■ <br /> CM'MB,a„Naw CNe/) <br /> IntSurvey Form -.Page 1 <br /> Calllomla egrated Waste Management Board <br /> 'art A-Surveir BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- , I ?J p D f 1 6 6 I - o Inspection Type (Fill one) <br /> Site Suffix: Il O 0 Routine Q Re-inspection. 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: SCL/t Q/QljGri�r �� / 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit.0 Other <br /> Business or Facility Name 41 <br /> ^ Inspected By /l Inspec� <br /> (Physicalical A� 2 9 ! O I / I 2Z18 "A 7121ilg�, <br /> Street <br /> Inspection Date <br /> 9s�39 <br /> City State ZIP Code Time In Time Out <br /> Business Rep Title O AM O'AM <br /> m-mOPM m'm OPM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) LL (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> r 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> D l0 Closed 0 Altered <br /> GPS Latitude I I 1 0 Hauler 0 Indoor. <br /> 0 Inactive 0 Truck. <br /> Longitude — I I I 1 1 lu 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) II 111 LL III <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader . 0 Dismantler 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 <br /> Part B-Inspection of Waste Tire Dealer,Generator,Hauler and End-Use Facility ENFORCEMENT STATUS <br /> �A�kMAULING.ANO MANIF.ESIT16 EQUIREMEN-- I 0 Notice . Violation 0 Extension <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. tromp lance Deadline <br /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements Date m <br /> 0 0 14 CCR§18459.1(a)(b)(c)-Tire Program ID Number from CIWMB <br /> 0 0 14 CCR§18459.2.1-Submittal of Manifest Forms and Tire Trip Logs within 90 days (Required for NOV or= <br /> 0 0 14 CCR§18459.3-Retention of Manifest Forms and Tire Trip Logs for 3 years <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred!C-IWMB 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 I C-ompliance - No Violations <br /> 0 0 Other: §. <br /> Comments . � eV_,.z W r 4ew-c1c.e.4-tz �O &-ewe ,>—e <br /> -7"7 2''y o.i .9 1� <br /> Inspection Form Included:0 <br /> Comments <br /> Business Rep's Signature Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK C_or�r�ect;� Irtcorr�t! i7 jEIXIAjMjP[LIEf 1112131 62061 <br /> ■ White Copy CIWM8 Yellow Copy.Operator Pink Copy LFA ■. <br />