Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number ■ <br />State of California <br />CalRecycle I 1 -1196403 <br />CalRecycle 181(Rev.10/10) <br />(Cal Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery(CalRecycle) <br />Part A - Survev BLUE OR BLACK INK PEN <br />Business Profile <br />V <br />Inspection Details <br />HAULING AND MANIFEST REQUIREMENTS <br />Q <br />TPID - ` <br />Site Suffix: L "1 D U `1 <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Inspection Type (Fill one) <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <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: 0 V OugkAl f\ COui� <br />IV <br />Business or Facility Name <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Inspected By Inspector <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Physical ddress <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />r s LO TT <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 <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />&A <br />X15330 <br />Inspection Date l } / <br />1 <br />, 3 <br />Other: § <br />Time In <br />Time Out <br />Business Rep Title <br />0" <br />r S <br />0" <br />\ <br />® PM <br />S PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE) <br />0 <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />® Active <br />Q Closed <br />Q Passenger <br />Q Altered <br />® Generator <br />Q Hauler <br />® Outdoor <br />Q Indoor <br />O <br />GPS Latitude <br />O <br />Q Inactive <br />® Truck <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 <br />Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <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 />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 />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 <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 />Q <br />Q <br />Other: § <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />Comments 2i n� — ` 1 r0_11% <br />jeike., C1l�ly` <br />f IX <br />1 <br />N o V 1.0"li ona 0i uLcrLl`�(�C Qntatn _ <br />Inspection Form Included: <br />Comments Included: <br />Business ep's Signature Phone Number Insp tor's Signature <br />hone Number <br />62081 <br />INSTRUCTIONS ON BACK Correct:0 Incorrect: Xa� E X I A M - L ELI 11213 <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink Copy L <br />N <br />N <br />N <br />I <br />a <br />N <br />0 <br />0 <br />x <br />