Laserfiche WebLink
Waste Tire Sw, vey & Inspection Repor . -Inspection Report Number ■ <br />Cal Rec cle State of California <br />Y CalRecycle 181 (Rev. 10/10)Survey Form -Page 1 I1 -1176415 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Survey <br />+ n _ c� �. —, BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID - <br />Site Suffix: Q <br />Inspection Type (Fill one) <br />® Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Local <br />Identifier: ' ���✓�� �✓✓L <br />Business or Facility Name <br />Inspected By Inspector <br />Physical ddress <br />Ayztrq LA&,,_ <br />-7 <br />Inspection Date 1 <br />CA o <br />t <br />"533 <br />Time In Time Out <br />Business Rep Title <br />O AM O AM <br />• 1 � ®PM � � 157�PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)(Fill <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />® Active <br />Q Passenger <br />(a Generator <br />Q Outdoor <br />Q Closed <br />Q Altered <br />Q Hauler <br />141A <br />Q Indoor <br />C <br />GPS Latitude <br />Q Inactive <br />®Truck <br />O <br />Longitude - <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair ® 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 Q Other <br />Part <br />B - <br />Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />ENFORCEMENT STATUS <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q Notice Of Violation Q Extension <br />Q <br />Q <br />PRC 42951 Waste Tire Hauler Registration and Transport of Tires <br />§ - <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Compliance Deadline <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Date M/m/m <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />(Required for NOV or EXE <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q Referred / CalRecycle Enforcement <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />® In Compliance - No Violations <br />Q <br />Q <br />Other: § <br />Comments <br />See <br />Inspection Form Included: Q <br />Comments Included: <br />- _ - - - <br />m e 's Signature Phone Number Iris or' S' nature Phone Number <br />62081 <br />INSTRUCTIONS ON BACK Correct: 1, Incorrect: � w g E X A M EK 213 <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink Cop :LEA ® 0 <br />