Laserfiche WebLink
Waste Tire SL ,y & Inspection Repor. ispection Report Number <br /> State B California Il - 1140556 <br /> 0410 <br /> California Ine grat dt81 WaseeManagement Board Survey Form - Page 1 <br /> Part A- S_urvey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- / Inspection Type (Fill one) <br /> Site Suffix: G a I ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: Q CHP Q CIWMB Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name - —- - <br /> Inspected By Inspector <br /> Physical <br /> sical Address <br /> a'�ls si Ala 2-G ' ;yi Are <br /> Inspection Date f <br /> lS,?o <br /> Time In Time Out <br /> Business Rep Title ® AM AM <br /> 64VLr.GCID v'nO �G�yG� / 0 ' 30 O PM 1 Q PM <br /> -- - <br /> Operational p Status Tire Type l Business Role Storage Type <br /> O <br /> Tire Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ' ' ® Active ® Passenger ® Generator Q Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude - Q Hauler I ®Indoor <br /> O Q Inactive Q 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 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 A/V C R14--S <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 <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 NOVorEXT) <br /> 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 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 1 Q Other: § <br /> Comments <br /> - <br /> fU�r�tr��.-moi <br /> Inspection Form Included: <br /> Comments Included: - - — � �41.1S3 <br /> Busin s Re s Signature Phone Number pector's Signa ure Phone Number <br /> INSTRUCTIONS ON BA K i�arect Incorr #� �� l� ' p 62081 <br /> White Copy:CIWMB Yellow Copy:Operator Pink C py: <br />