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0. HAULER OBSERVATION REPORT <br /> CalRecycle CaIR�ale 775(New 2/14) <br /> Dept afResowcec Rmydl,S end P­­y BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> O TPID-not available/not applicable Observation during inspection at: <br /> TPID- O b i '31-7 ] <br /> Generator 0 End—Use Facility 0 Other: <br /> � g '� <br /> Vehicle TPID-It 13121011 6 _ <br /> Plate State 0 Observation in transit <br /> Decal Observation by Inspector <br /> Number m ?�- q - ` Q rA N'T T V <br /> (If Applica- <br /> p Hauler Exempt: Observation Date <br /> O Hauler name&address not known <br /> Hauler T f� Observation Time <br /> �1sev�, 1�9c►.y Tice.Cow.ea�,Y,iY�C.•C��` �� © O AM <br /> Hauler Address PM <br /> 221 IV.W�\gp,n WO� <br /> street ENFORCEMENT STATUS <br /> city state Zip Code O Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> 10 led 11J ���,\.4e Referred/Ca lRecycle, Tire Hauler Compliance Unit <br /> Street S 377 <br /> Tcd-c-y For more information concerning Waste/Used Tire <br /> City State zip code Hauling&Manifesting,please call the Waste Tire <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> O O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Official <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle 0 O 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle O O Other§ <br /> Comments/Driver's Statement: <br /> t� �{ <br /> -T:Q�- GcovQ��, 13�oLbl=-Qt� 2�eC(� ✓>._' 3 €5T.5�_ <br /> 113 040 b a� c ._�Sb���•r•es� ,,,m,� �e,S <br /> 9Ts_-.a. anec�._�_� L <br /> Comment Form O <br /> 21-465- 28`� <br /> Photos 0 Driver's Signature Phone Number Ins ctor's Signature Phone Number <br /> Correct: Incorrect: X 4 <br />