Laserfiche WebLink
Waste Tire Sur vey & Inspection Report Inspection Report Number <br /> CalRecycle Cte of alRecyclel' ia 181n(Rev.10/10) 11 - 1196652 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) Su rvey Form - Page 1 <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- 1 _73 9 I C� 1 _ Inspection Type(Fill one) <br /> Site Suffix: U 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: ,^ ��, ry V;Y-\ Co 0 CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> (}!� S0.v� .)�V� Inspected By Inspector <br /> N 1VA.. W S\C- Sec�;ccS C�Jn r .� _ 1 O ` M A`V T v <br /> Physical Address <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title \\ �\ 0 AM 1 AM <br /> 1 v ' O O 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 /> 0 Active 0 Passenger 0 Generator Q Outdoor <br /> O 0 Closed O Altered <br /> GPS Latitude 4D Hauler Q Ind or <br /> O Q Inactive 0 Truck <br /> Longitude - 0 End-Use 0 Container <br /> 0 Planned A OTR <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer 0 Auto Repair Trucking Fleet Q Government 0 Retreader 0 Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer 0 Auto Body Q Car Dealer 0 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 <br /> Q Notice Of Violation Q Extension <br /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 0 O PRC§42956-Registration/Decal in Vehicle <br /> 0 O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m <br /> 0 O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> a <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> LU <br /> W <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> O 0 <br /> Other:§ <br /> Comments 1•n°.��C�� Cb`1�ciY�2 ��C�� Jt� 1Y���2G \(Z1L� �`�R _e%w\ <br /> S <br /> Inspection Form Included: Q ld _q_Ut 0 -2-2 <br /> Comments Included: Oma— �J"� <br /> Business Rep's Signature Phone Number Inspec or's Signature Phone Number <br /> ,-�( 62081 <br /> INSTRUCTIONS ON BACK [Correct0 Incorrect: X � qJ E X A�E 1 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA © ■ <br />