Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number ■ <br /> CalRecycle State of California I 1 -1176781 <br /> CalRecycle 181(Rev.10/10) � � <br /> Dept.of Resources Recycling and Recovery(CalRecycle) Survey Form �J�ae <br /> BLUE OR BLACK INK PEN <br /> Part A-Survey <br /> Business Profile Inspection Details <br /> TPID- ' Inspection Type(Fill one) <br /> Site Suffix: Ll 0 l LLl C l ®Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local l If Referral,choose referral type(Fill one) <br /> Identifier: �C.�� '•'VCI�`�� C�'� i�1 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> C, \e yymCA. tTC Lie, <br /> Physical Address J (�� <br /> U 1 ( �' / Inspection Date <br /> L.�oc�yvp `^ Cl 333) TimeInIn Time Out <br /> Business Rep Title / <br /> C AM AM <br /> 0 P ! L 0 0 P <br /> oeY mcv chat <br /> Operational Status Tire Type Business Role Storage Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) �-- <br /> 0 Active 0 Passenger jo Generator 0 Outdoor <br /> O 0 Closed 0 Altered 'V 1A <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O Q Inactive 4 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair IV 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 <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS 0 Notice of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / 0 / 0 <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days — (Required for NOV or EXE <br /> r <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> W <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments <br /> en <br /> Inspection Form Included: 0 <br /> e <br /> Comments Included: <br /> Business Rep's Signaturg Phone Number Ins s S' lure Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: E �C L E 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />