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*a V& <br /> .............. <br /> HAULER OBSERVATION REPORT <br /> CalRecycle CalReryce775(New 7J14) <br /> Drpt.of Remurces Recycling and Recovery BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> Q TPID-not available/not applicable ® Observation during inspection at: <br /> ® Generator O End—Use Facility O Other: <br /> TPID- � O � Z � � —� TPID- I y' p <br /> Vehicle State F <br /> Plate J Q Observation in transit <br /> Decal <br /> Observation by Inspector <br /> Number m r� / ()— <br /> (If Applica- <br /> Q Hauler Exempt: Observation Date <br /> Q Hauler name&address not known <br /> Haulerrn _/1/ bservation Time <br /> VVVss. �Q. I 1/ to 0 AM <br /> Hauler Address <br /> FFF ✓U\ �• PM <br /> street ENFORCEMENT STATUS <br /> City State Zip Code O Notice of Violation <br /> ✓�rZSn U r'- `31 �-Tote <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> /� <br /> ® Referred/Ca]Recycle, Tire Hauler Compliance Unit <br /> Street Q� ps�G rKk4- 4X9ni.--Q_ <br /> •✓` For more information concerning Waste/Used Tire <br /> Y <br /> City state Zip c e Hauling&Manifesting' Pg lease call the Waste Tire�'LQ r1}e c•� C/� Oi 5 3.3- <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport of Tires Q Q PRC§42956(c)-Failure to Present Registration to Official <br /> Q Q PRC§42952(b)-Falsely Represents Self as Registered Hauler Q O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle ® -0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle Q Q Other§ <br /> Comments/Driver's Statement: <br /> _G'r>✓ t(?�2�j� S a r�r i ~� 116flaC Pla wag 1-CIYI <br /> -,.a nAA_� S i1v . '�f 11 e �'1 CTZ— 0C., r10ji-- c ci_4L-rI Y-1 <br /> l&-Y cwts 6V Va ,z- rra S 5 CO. <br /> S e or.R. s sl -7o . f bt s i.Lr-ss .-5u en wta I-f,--o-S &,- <br /> Z by s� ria sem. S !o CIA D F GTZ' S d 425-0- <br /> Comment Form Q <br /> Zd£i'yby-z �� <br /> Photos ® Driver's Signature Phone Number Inspector's Signature Phone Number <br /> Correct: Incorrect: X �r <br />