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F 09308050023 <br /> Waste Tire Survey & Inspection ReportInspection Report Number <br /> CIWMBState Califoew Survey/ Form - Page 1 I 1 - 1141313 <br /> California Int g^t dtWaste Management Board Survey. <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- `��- Inspection Type (Fill one) <br /> Site Suffix: CL�-I-y �� ���—1 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local r — If Referral,choose referral type(Fill one) <br /> Identifier: l ��rt t/OQ��ccir! 0 CHP 0 CIWMB 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility aci ry Name <br /> Inspected By Inspector <br /> Physical &dress— -—. — " 3 17 I - ALO I�J L_ <br /> tStree! � - -- -- -- �S3 I LCQ <br /> I_ 1 0L �Inspection Date r I �/� 9 <br /> L—J_ � t_ <br /> City Sets ZIP Code Time In Time Out _ <br /> Business R t I ___1 <br /> G` Title , •AM �/� ���Q AM <br /> �L a'a r I P I J D O PM L( { .0 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 /> Active ® Passenger ®Generator ® Outdoor <br /> 0 Closed 0 Altered <br /> GPS .Latitude .L- 0 Hauler. 0 Indoor <br /> --- - —'--- 0 Inactive 0 Truck <br /> — - - ---- --- <br /> :o <br /> Longitude - ' i I . i i 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type (Fill all that apply) <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 I I <br /> Part:B - Ins ection of Waste Tire Dealer Generator Hauler and End-Use Facility ENFORCEMENT;STATUS$�� •, <br /> P r r Y :- <br /> VA .HAULING AND MANIF,ESRECUIREMENTS * , <br /> ..., .... .... ta.6iac�+�+.awis:•,a, <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> PRC§42953-Contracts with Registered Waste Tire Haulers. ti <br /> 0 Cgmpllance Deadline �.. � ,a•, ; <br /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459 -Responsible Entities Complying with Manifesting Requirements <br /> 0 14 CCR§18459.1 -Tire Program ID Number from CIWMB yi;•� t <br /> O O <br /> 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days ' (Required for)IOVor670 <br /> Vii: <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> #d#•&°sF� �` °.x's t„ -pi„>•t �q, <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred I ro CIWMB EnforcemeentY' <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities c:� � ,- `.F :•�,, <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators Q In Compliance �No�Violations � ;' <br /> 0 0 Other: § <br /> Comments ,y(Ocx <br /> 1 <br /> /�'.-� � j2c.t LGl�' t/'a�a�•�%+.r oe Gr�cGl'1 <br /> Uo= � �y'_/""• ''19'Z <br /> - �� - _ Y� 9s3 - ruc r�S w r% <br /> Inspection Form Included: 0 <br /> Comments Included: 0 - — - - - — U <br /> siness ep's gnatu a Phone Number Inspector's Signature Phone Number <br /> —� 62081 <br /> INSTRUCTIONS ON BACK C r"ect: Incorrect: ( l r�X AIM p r 2 3 <br /> WhiteC y:CI Yellow Copy Operator Pink Copy:LEA <br /> Ctr ® ■ <br />