Laserfiche WebLink
2 Waste Tireefty & Inspection Rep AkAiIIIIIIIIIIIIIiii, <br /> pection Report Number <br /> CalRecycle State of California - <br /> CalRecycle 161(Rev. (Cal Survey Form - Page 77, 1176542 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A- Survey _-_ - - _— BLU_E OR BLACK INK PEN <br /> I Business Profile Inspection Details <br /> TPID- / Inspection Type(Fill one) <br /> Site Suffix: (p Q ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: �� d1, � � Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> i"A , `- - <br /> Physical Address <br /> Inspection Date O <br /> Lod; r4 rrz ya <br /> Time In Time Out <br /> Business Rep TitleQ © OAM A 3 ®AM <br /> C U Q PM <br /> o ma- <br /> Operational <br /> 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 /> ® Active ® Passenger ® Generator ® Outdoor <br /> Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude — Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q 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 Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other <br /> r <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility rENFORCEMENT STATUS <br /> VA 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 /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q (Required for NOV or EXT) N <br /> 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> ®In Compliance-No Violations <br /> Q , . Other:§ J <br /> Comments <br /> — �'�,L1�eui/��.G.� ii'1 C/J!,✓�C/Y� —���G [•CCtL4,�����%�--T�� ,.. <br /> Inspection Form Included: Q <br /> I Comments Included: � <br /> es Rep s Signature Phone Number Inspector's Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK �Correct.I* Incorrect X E I X I A I M P L E 1 2 3 <br /> ® White Copy:CalRecycle Yellow Copy:Operator Pink Copy: E © ■ <br />