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Survey & Inspection Rep - Survey Form (Page 1) Page 2 of 3 <br /> ❑Auto Repair ❑ Car Dealer ❑ Shredder ❑Tire Derived Fuel <br /> ❑Other Business Type Other: <br /> Part B - Inspection of Waste Tire Dealer, Generator, and End-Use Facility <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler, and End- <br /> Use Facility <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> ❑ ❑ PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br /> ❑ ❑ PRC § 42953 - Contracts with Registered Waste Tire Haulers <br /> ❑ ❑ PRC § 42956 - Hauler Registration/Decal in Vehicle <br /> ❑ ❑ 14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br /> ❑ ❑ 14 CCR § 18459.1 - Tire Program ID Number and Certificate from CalRecycle <br /> ❑ ❑ 14 CCR § 18459.2.1 - Submittal of Manifest Forms and Tire Trip Logs within 90 days <br /> ❑ ❑ 14 CCR § 18459.3 - Retention of Manifest Forms and Tire Trip Logs for 3 years <br /> ❑ ❑ 14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br /> ❑ ❑ 14 CCR § 18461 - Manifest System Requirements for Waste Tire End-Use Facilities <br /> ❑ ❑ 14 CCR § 18462 - Manifest System Requirements for Waste Tire Generators <br /> ❑ ❑ Other 14 CCR § <br /> ENFORCEMENT STATUS <br /> ONotice of Violation OExtension <br /> Compliance Deadline: <br /> (Required for NOV or EXT) <br /> OReferred / CalRecycle Enforcement <br /> *In Compliance - No Violations <br /> Comments: <br /> rk A I Paragraph Font Family Font Sizes — <br /> Routine waste tire inspection done on this date and the following was noted: <br /> No violations or areas of concern <br /> Notes: 1. Permission to conduct inspection given by Brittney Miller, Service Manager. <br /> Signatures <br /> ❑Inspector's Signature ❑ Business Rep's Signature <br /> https:Hsecure.calrecycIe.ca.gov/WTMS/Inspection/Survey.aspx?SurveyID=... 7/21/2016 <br />