Laserfiche WebLink
Waste Tire $&ey & Inspection Repor Inspection Report Number <br /> Cal Recycle State of California I 1 - 1226299 <br /> CalRecycle lR(Rry ev. (Cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recove (CalRecycle) <br /> Part A- Survey__------ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- t r J / Inspection Type(Fill one) <br /> Site Suffix: O b d I ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: N 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> --T--T—,s t L <br /> Physical Address 3 / (' / &oFo-eT/ / <br /> S• !� <br /> C�1 Inspection Date 1 / ` L/ / <br /> Time In Time Out <br /> Business Rep Title O AM _ 0 AM <br /> a O C) ® PM ® PM <br /> Ar t� 1 s <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 0 Outdoor <br /> GPS Latitude 0 Closed 0 Altered 0 Hauler ® Indoor <br /> O 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other <br /> z"Icl7na 9"�ty� <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 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 m / m / m <br /> 0 0 14 CCR§ 18459.1 -Tire Program ID Number from CalRecycle v <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or E)C7) <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 W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> 0 1 0 1 Other:§ <br /> Comments <br /> �C�r 1242&- ; - - - - <br /> Inspection Form Included: 0 Comments Included: 0 �BZA& Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK [Correct:0 Incorrect X (�� _JXA M L 1 2 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Cop <br />