Laserfiche WebLink
■ `i== Waste Tire Sup Y�ey & Inspection Report Inspection Report Number ■ <br /> llri State of California — <br /> CIWMB 181( e ) <br /> California Integrated WasttManage <br /> Waste Management Board Survey Form - Page 1 Il 1143998 <br /> Part A- Survey_ _ BLUE OR BLACK INK PEN <br /> 'Business Profile Inspection Details <br /> TPID- _ Q Inspection Type (Fill one) <br /> Site Suffix: d I 9 Routine Q Re-inspection Q Referral Q Observation <br /> - S <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: <br /> (A0 dA L& Ck-AX4 Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> � <br /> prakip `T c u,c,��nPhysical -3 _ t OPiv) E�l wito <br /> r'c n t,NnCA q5a Inspection Date 1 <br /> rn eI <br /> Time In Time Out <br /> Business Rep Title + S O AM c O AM <br /> Ff 2(1lD 1 \ 0.�� O W{� ® PM � J 5 � 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 /> Is Active 0 Passenger • Generator (a Outdoor <br /> 0 Q Closed Q Altered <br /> GPS Latitude _ Q Hauler Q Indoor <br /> 0 Q Inactive Truck <br /> Longitude - - Q Planned Q OTR �Q End-Use Q Container <br /> Business Type (Fill all that apply) <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 /> 1 <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <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 Date 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 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/CIWMB Enforcement <br /> Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> 00 ® In Compliance - No Violations <br /> Q O (Other: § <br /> Comments <br /> 1 ��r�, 1�� ��_.. - - Ia11S�W�C L <br /> rr IN,W QICt.-- - <br /> �1 o v i 0t14)' <br /> Inspection Form Included: oI C15 W Q <br /> Comments Included: ® J <br /> !�� <br /> Bu ss Rep ignature Phone NumberqInspe or's.ignature Phone Number <br /> 62081 <br /> INSTRUCTIONS O ACK Correct:* Incorrect X �X A 4 I p 23 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pin C A <br />