Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number ■ <br /> State of California <br /> CalRecycle CalRecycle 181(Rev.10/10) Page 1 11 - 1196393 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) Survey Form <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> Site Suffix: 6 0 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: sac) Jov �14111'\ co W4� 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address <br /> A-\S.s 14 S �30J CJ o <br /> Inspection Date 3 <br /> Time In Time Out <br /> Business Rep Title OAM 0 AM <br /> iii Lk Q�0 S6�0 C'nck' (r 0 PM 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 /> 6 Active A Passenger 0 Generator 0 Outdoor <br /> GPS Latitude 0 0 Closed Altered 0 Hauler 0 Indoor <br /> 0 0 Inactive Truck <br /> Longitude 0 Planned OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler Tire Derived Fuel <br /> & Used Tire Dealer 0 Auto Body 0 Car Dealer ft 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 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 Mal <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 EXT) <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <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 <br /> 0 in compliance-No Violations <br /> 0 0 Other:§ <br /> Comments <br /> Cl <br /> S. n <br /> Inspection Formnc�uded: <br /> Comments�nc Included: C1 16-V13-Lj-4()q <br /> Business P's Sinature Phone Number Insp or's Signatur Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: 07 JEJXJAJ 1 111213 62081 <br /> ■ X q] <br /> White Copy:CalRecycle Yellow Copy:Operator Pink C ---- ■ <br />