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HAULER OBSERVATION REPORT <br /> CalRecycle SCta�IRe ycicle 775(New 7/14) <br /> Dept.of Resources Recycling and Rewvery BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> O TPID-not available/not applicable ® Observation during inspection at: <br /> O Generator 0 End—Use Facility 0 Other: <br /> TPID- v Z 1�_ 4 4 —© TPID- j y dfTj ?j W-I Z- <br /> - U <br /> Vehicle State <br /> Plate 0 Observation in transit <br /> Decal Observation by Inspector <br /> Number m c� J I ` #Pi-xVM'-L-. 1t) <br /> (If Applica- <br /> O Hauler Exempt: Observation Date <br /> O Hauler name&address not known <br /> Observation Time <br /> Hauler O <br /> Ve- 1.T enMra <br /> � �; d ® <br /> Hauler Address <br /> StreetENFORCEMENT STATUS <br /> 2 S� S_OLS__ C kej,V; �-v.RJtiu�Q <br /> city State Zip Code O Notice of Violation <br /> T-i'.aS n-O °1 � tP <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> ® Referred/CalRecycle, Tire Hauler Compliance Unit <br /> Street 07 f2fie I I_S5 C ^-r <br /> V -- r`t` - For more information concerning Waste/Used Tire <br /> City State zip co e Hauling&Manifesting, please call the Waste Tire <br /> Yka vL �� C/f 015 3 } Hotline at(866) 896-0600. <br /> Tire Load Count ❑ <br /> (used+waste) � <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> O O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Official <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler O Q 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle 0 -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 /> n�-c,P-iz-t� <br /> V�tG,,t an cu.�-�► Ue�L(� �. ,a C c, C C f P c z.-o iac�r A_� <br /> 01- <br /> C) an_s ot,- rin i— cc-i.2a-r Y-,I'%.-n"ou X-fc V ��,.��u Or+R S s ea, <br /> f— <br /> S� QrR Sl tz-tS-1 -7 `,fief boss eui ss sven✓�_I�_P r- 41 - <br /> ZAD— <br /> Comment Form <br /> O <br /> Photos 9 Driver's Signature Phone Number Inspector's Signature Phone Number <br /> Correct: Incorrect: X * <br />