Laserfiche WebLink
Waste Tire Sull vey & Inspection Report- Inspection Report Number <br /> CalRecycle <br /> State <br /> California <br /> — • <br /> YCalRecycle ( Survey Form - Page 1 I1 1177736 <br /> Dept of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Ll Inspection Type(Fill one) <br /> Site Suffix: 1 , Ct of l 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier �!�� �( v��/1 ���/t/�/ O CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility NlameL ( /� Inspected By Inspector <br /> Phys� jAdd31 Physical ress CLn p � �1 <br /> lc?aLl tl1 _ 1� � T7ry `"/a /-t <br /> Inspection Date 5- 7 3 C <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> t : L! O O PM C7 S 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 /> ' ' •� O Active O Passenger Generator Q Outdoor <br /> D Q Closed O Altered *10 <br /> GPS Latitude Q Hauler O Indoor <br /> O Q Inactive ® Truck <br /> Longitude - Q Planned ® OTR O End-Use O Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair I*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 O 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 /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> O 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> O 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> O 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> Other:§ - - <br /> Comments <br /> Ser <br /> p O <br /> Inspection Form Included: <br /> Comments Included: 0-4 <br /> -y <br /> Busi ess Rep's Sgature Phone Number .Ins ec or' i a re Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: E X A 1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Cop :L ® ■ <br />