Laserfiche WebLink
X. <br />r.� <br />Waste Tire Survey & Inspection Report Inspection Report Number <br />CalRecycle State of California 11-1242084 <br />CalRecycle181(Rev.10/10) Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) BLUE OR BLACK INK PEN <br />Part A - Survey- — <br />Business Profile Inspection Details <br />TPID -Q <br />Site Suffix: I -77 <br />Q <br />t O <br />1 <br />l <br />Inspection Type (Fill one) <br />® Routine Q Re -inspection Q Referral Q Observation <br />Local <br />Identifier: �G" Jam <br />Y\ <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Business orFacility Name <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Inspected By Inspector <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />Physical Addr §s <br />0 <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />O <br />2,X102 5. CLAN ; �ovV':�c1- <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />O <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />O <br />Inspection Date c3 <br />St -_ \ l v <br />� <br />o� <br />Time Out <br />�IC.-K-`\ oV-\ <br />O <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Time In <br />Business Rep <br />Title <br />II AM <br />1 Q PM L S O PM <br />9_6h fie— <br />n <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />Tire Count (Whole/PTE) <br />, <br />! Active <br />Q Passenger <br />9 Generator <br />Q Outdoor <br />GPS Latitude <br />O <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />Q Inactive <br />0 Truck <br />Longitude — <br />O <br />O Planned <br />Q OTR <br />Q End -Use <br />Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair 40 Trucking Fleet <br />Q Government Q Retreader Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body <br />Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler <br />Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />O <br />O <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />O <br />O <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />0 <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />O <br />O <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />O <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />O <br />O <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />O <br />O <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />O <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />O <br />Other: § <br />Comments <br />Inspection Form Included: Q <br />Comments Included: 40 <br />Busines ep's Signature Phone Number <br />INSTRUCTIONS ON BACK Correct:* I correct: X <br />■ White Copy: CalRecycle Yellow Copy: Operator <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date <br />(Required for NOV or EXT) <br />Q Referred / CalRecycle Enforcement <br />In Compliance - No Violations <br />V\ - <br />VAa <br />Insptor's Signature Phone Number <br />EXAMPLE 123 62081 <br />Pink Copy: LFA <br />I <br />i3 <br />r` <br />LU <br />