Laserfiche WebLink
2 Waste Tire S. Bey & Inspection Repor Inspection Report Number <br /> Cal Recycle State of California 11 - 1176571 <br /> CalRecycle 181(Rev. (cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A- Survey BLUE OR BLACK INK PEN_ <br /> Business Profile Inspection Details <br /> TPID- r r LL _ ( Inspection Type(Fill one) <br /> Site Suffix: Z b T ® Routine Q Re-inspection Q Referral Q Observation <br /> Local � �� If Referral,choose referral type(Fill one) <br /> Identifier: O CHP O CalRecycle Q Complaint Q Educational Visit O Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> Physical Address Q 91-1-44,M1 <br /> q 3 5 <br /> Inspection Date l) Q <br /> Time In Time Out <br /> Business Rep Title ® AM ® AM <br /> — j / ® . D Q Q PM 4 O 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 /> 50 Q Active 0 Passenger g Q Generator Q Outdoor <br /> O ® Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive Q Truck <br /> Longitude - U <br /> d- se <br /> O En <br /> Q Planned Q OTR Container <br /> Business Type(Fill all that apply) WA N1 A dV/A <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q 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 0 Extension <br /> O O PRC§42951 Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> O O PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> O Q 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 EXT) N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> O 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers O Referred/CalRecycle Enforcement f <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities _- W <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations <br /> Other:§ - - <br /> Comments <br /> a144 a( <br /> ZG444 in.4 _t. C 010 k rJ <br /> Inspection Form Included: O <br /> Comments Included: <br /> Business Rep's Signature Phone Numberspector's Signature Phone Number <br /> I - — /-� <br /> INSTRUCTIONS ON BACK ;Correct. Incorrect: � � EXAM L E 2 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Co y:L <br />