Laserfiche WebLink
Waste Tire <br /> Sue & Inspection Report inspection Report Number <br /> State of CaliforniaCalRecycle <br /> ■ <br /> CalRecycle 181(Rev. (C <br /> Dept.of Resources Recycling and Recovery(CalRecycle) Survey <br /> Recycle) Survey Form - Page 1 I1 - 1177844 <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> Site Suffix: _1 1 `$ Routine Q Re-inspection Q Referral Q Observation <br /> Local �-- _^ If Referral,choose referral type(Fill one) <br /> Identifier: J lilll^ rWun j Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> esGcf'�P(An <br /> Physical Address I Es 1i0 <br /> ��-la1 C�us1z OS _ U-lJ <br /> Inspection Date / 8 / I 3 <br /> Time In Time Out <br /> Business Rep Title0 5 O (ItAM ` 91 AM <br /> �O 4O4 1 M t M(�G< <f O PM ) a 5 O PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) 5 I J (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ® Active It Passenger 1100 Generator 0 Outdoor <br /> Q Closed Q Altered <br /> GPS Latitude Q Hauler Q 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 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 /> 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 CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EX7) N <br /> a <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> Q Q1 Other:§§ <br /> Comments -YO-1 <br /> Inspection Form Included: Q <br /> Comments Included: –� <br /> gusiness Phone Number Insp tor's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: � W 62081 <br /> EXAM E 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Cop : E © . <br />