Laserfiche WebLink
Waste Tire Survey & Inspection Report inspection Report Number ■ <br /> CalRec cle State of California <br /> Y CalRecycle 18.1(Rev.10/10) Survey Form - Page 1 1 1230232 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> BLUE OR BLACK INK PEN <br /> Part A-Survey <br /> Business Profile Inspection Details <br /> TPID- / Z I RE <br /> pe(Fill one) <br /> Site Suffix: ? / ' 0 Re-inspection 0 Referral 0 Observation <br /> Local oose referral type(Fill one) <br /> Identifier: r Co Vdl 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name V Inspected By Inspector <br /> Physical Ad s � <br /> o66 mef <br /> 44oc.�_� � �S2o3 <br /> - <br /> C� Inspection Date ' 2- <br /> Time In Time Out <br /> Business Rep Title -. J� '.M ` ) ® AM <br /> 1 V O PM l 1 0 PM <br /> Operational Status Tire Type Business Role Storage Type <br /> (Fill one only) I (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whol PT <br /> 40 Active I♦ Paaslarger �Generator 0 Outdoor <br /> GPS Latitude O 0 Closed 0 Altemd 0 Hauler 0 Indoor <br /> O 0 Inactive 0 TruCk <br /> Longitude - 0 Planned 0 OTA 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retrwder 0 Dismantler 0 Tire Derived Fuel <br /> Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crump 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 /> 0 0 - — { 0 Notice Of Violation 0 Extension <br /> 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 <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) N <br /> a <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred CalRecycle Enforcement <br /> W <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 In Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments k,12S, <br /> Inspection Form Included: 0 �D 41nspctor"s <br /> Comments Included: 0Businep's Si re Phone Number Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: A W EXAMPLE 1 2 3 <br /> . White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />