Laserfiche WebLink
Waste Tire Sup Bey & Inspe don Report Inspection Report Number <br /> CalRecycle State of California <br /> CalRecycle 181(Rev.10/10) C�W/ey �OFrl fil o p��® 11 1242359 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) Survey� V �1 ��U e <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- � � n ( m ® ' Inspection Type(Fill one) <br /> Site Suffix: I ` (7 'o Routine Q Re-inspection Q Referral Q Observation <br /> Local ` o If Referral,choose referral type(Fill one) <br /> Identifier. �0.�Y1 �c�d - Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> `� CSD <br /> Business nor Facility Name Inspected By Inspector <br /> Physical Add <br /> eresse 1 b�� 1 1 ^ -Vey v <br /> Inspection Date C� 2 / _Z <br /> Time In Time Out <br /> Business Rep Title z 0 AM O AM <br /> 9 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 /> ' Q Active Q Passenger Q Generator Q Outdoor <br /> o 0 Closed Q Altered jj r Q Ingo �_�aP� Latitude iv QHauler <br /> O Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer 0 Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body 0 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 Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <br /> a <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> W <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> Q 1 Q 1 Other:§ <br /> Comments <br /> C:.wS <br /> —v <br /> Inspection Form Included: Q <br /> Comments Included: O <br /> -� <br /> usiness Rep's ignature Phone Number Inspec is ignature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: IEIXIAIMIPILIEI 1112L3] <br /> 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />