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HAULER OBSERVATION REPORT <br /> Sc77sCalRecycle CaMcya (New 2/14) <br /> rxp.dx—P—cydi�8.dRr y BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> 0 TPID-not available/not applicable ® Observation during inspection at: <br /> TPID- V Z 5- 4 [+ — G� i 0 Generator 0 End—Use Facility 0 Other: <br /> Vehicle TPID-11 �- / 1 � `1 I]— O <br /> State Observation in transit <br /> Plate _0 ..__--_----••-..._..... . ._...... :. ... --. ._._ .._._ <br /> Decal <br /> Observation by Inspector <br /> m _ _ <br /> Number <br /> (If Applica- <br /> 0 Hauler Exempt: Observation Date <br /> _ 0 Hauler name&address not known <br /> Hauler !��J _, fin/ Observation Time <br /> ✓� IZQ L_ ! II� ��I/�C�IE JJ`v' ® AM <br /> Hauler Address (J+ 0 PM_._. ___ z; ENFORCEMENT STATUS <br /> Street <br /> r,0 Notice,ofVlolation - <br /> City State Zip Cade <br /> Compliance Deadline <br /> Driver's Name D.O.B. ` <br /> Location o Ob ervatlon J, <br /> Referred/Ca lRecycle, Tire,Hauler Com <br /> plli aance Unit <br /> Street �® <br /> Ltd For more information concerning Waste/Used Tire <br /> city State Zip Code Hauling&Manifesting,please call the Waste Tire <br /> Tire Load st Count <br /> ❑' <br /> Hotline at 866 896-0600. <br /> used'+waste <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires O 0 PRC§42956(c)-Failure to Present Registration to Official <br /> 0 0 PRC§.42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 0 PRC§42956(a)-Registration/Decal In Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments/Driver's Statement: <br /> G i7 l 1 b`t I S <br /> G-714 11 le D06 K- ��►-�. ' <br /> W It IZOii%e1 leri x�c�t ®( foaz 4y _0 <br /> r�ac, ovt G 4 ' di PC#- a ojoct r ir, oL —_ <br /> X1-1ZSS-77-3 SQA, hv :5 incEr e-eo rr-+^ ni-1,144-k- 2- <br /> Som <br /> Som r ea,�ta of C/ZZ's D bso>-ixt .Q, e"sz <br /> Comment Form 0 <br /> Photos 0 Driver's Signature Phone Number Inspector's Signature Phone Number <br /> Correct: Incorrect: X <br />