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HAULER OBSERVATION REPORT observation Report Number <br /> CaRzecycle srrtcofGlifamit IH-3XXXXXX <br /> CetReeycle X7tX(xev zx�e} <br /> BLUE OR BLACK INK PEN <br /> ME " <br /> O :TPI❑-not ave;lable(not applicable <br /> Observationduring inspection at:(birte-tt .iAr'Q_ Cr). <br /> TPID- j 6 - 5 1 <br /> 0Generator 0 End-Use.Facility 0 Other. <br /> Vehidt~ � � � , <br /> IPID= r 3 <br /> Plate Lj —7 4 State G O Observation in transit <br /> Decal Observation by Inspector <br /> Numberc-� — ® )� 1.' <br /> (lraav9$cabia) <br /> Observation Date <br /> [) 'hauler Exempt <br /> I Hauser Name <br /> Observation Time <br /> Hauler Address 0 PM <br /> Street l <br /> C� U( 3 ?Li b <br /> City State Zip Code <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> trees a w y ..�.. r� , <br /> C/A C'SaGT- For more information concerning WastelUsed Tire <br /> city. state Zip Code .Hauling&Manifesting,please call the Waste Tire <br /> f tr a=. t <br /> G : Hotline at(866) 896-0500. <br /> a-u�i r, <br /> -se }x s� o r , ri <br /> �r ��G11-.(Lt�'.��.x.�f9`�,. 5�,,".4.ijsk,i�..l�la' <br /> Part B- <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport oFTres O O PRC§42959(c)-Faliure to Present Reglstratlon to Official <br /> Q Q PRC§42952(b)-Falsely Represents Self as Registered Hauler Q Q 14 CCR§.18455.4—Failure to Abide by Tempor,iry Registration <br /> O O PRC§42659(a) Registradon/Decal in Vehicie 0 Q 14 CCR§18459-t�Hauler Complying wth Manirestin�Requirements <br /> 0 0 PRC§42956(b)-Hauler Using-an Unregistered Vehicle ® Q Other'§ V4 LCpi fs ti'3'1 C-b0"3 K <br /> Comments 1 Driver's Statement: <br /> I� <br /> iaa __ -. t m Y_:' -- <br /> _.._. VI11Rr_ tc����i�J_._ <br /> Ale <br /> r rte„" <br /> I am <br /> St <br /> �i > <br /> i. e <br /> �� 0 a NOW � <br /> t3- I? e , <br /> �a <br /> D i i 7 <br /> 9� �r,� •aft ,� � � <br /> ^ffi�l ,�"?..ati:�45r'.rrdr�.:10-."�il`• 1 �,.. .�i:��,"�. -.. I .: a,"-`.:..:'��...:-s�.�. �- .? ,....::l::s. <br /> Correct: incorrect, <br />