Laserfiche WebLink
.. . .. .......... ... <br /> ......... <br /> __T <br /> Inspection Report Number <br /> Tire Survey & Inspection Report I11 -1176355 <br /> CalRecycle State of California <br /> CalRecycle 181(Rev.10/10) Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) BLUE OR BLACK INK PEN <br /> Part A- Survey Inspection Details <br /> Business Profile <br /> Inspection Type(Fill one) <br /> TPID- <br /> Site Suffix: 9 6 ol <br /> ®Routine 0 Re-inspection 0 Referral 0 Observation <br /> 1 (J - <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or—Facility Name Inspected By Inspector <br /> E)e'n <br /> Physical Address <br /> Got[ c3 . 3e_y1ykynIVA t�k-� 0"r Inspection Date 09 t <br /> CA (15�9tel Time In Time Out <br /> Title 0 AM _ 0 AM <br /> Business Rep 7 PM <br /> a PM <br /> Storage Type <br /> Operational Status Tire Type Business Role (Fill all that apply) <br /> (Fill one only) (Fill all that apply) (Fill all that apply) <br /> Tire Count (Whole/PTE) 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> 0 0 Closed 0 Altered <br /> Latitude 'YIA 0 Hauler 0 indoor <br /> pS <br /> G 0 0 Inactive 0 Truck 0 End-Use 0 Container <br /> Longitude 0 Planned 0 OTR <br /> Business Type(Fill all that apply) Retreader <br /> 0 Dismantler 0 Tire Derived Fuel <br /> 0 Auto Repair 0 Trucking Fleet 0 Government 0 <br /> Q New Tire Dealer0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 10 Other 6r,-s <br /> Part B - inspection of Waste Tire Dealer, Generator, Hauler and End-Use FacilitY ��ENF:05ACEMENT STATUS <br /> HAULING AND MANIFEST REQUIREMENTS 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[]—] <br /> m / N <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle (Required for NOV or EX7) <br /> Q 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days <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 Eni.orcement <br /> ui <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 I&In Compliance-No Violations <br /> 0 0 Other:§ <br /> Comments <br /> +- 4k,as <br /> cAo,,e <br /> Inspection Form Included: 0 <br /> Comments Included: 0 Phone Number n e ure Phone Number <br /> Business Rep's Signature 62081 <br /> ("7') 1 2 <br /> INSTRUCTIONS ON BACK F�orect.0 Incorrect: W 9� E A_r_ <br /> White Copy:CalRecycle Yellow Copy:operator Pink Cop :,L <br />