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Survey & Inspection Report Wey Form (Page 1) 0 Page 1 of 3 <br />Report is in SUBMITTED status — CalRecycle approval of this inspection report is <br />pending. <br />Survey Submitted for CalRecycle review. <br />Part A - Survey <br />Create PDF from this 0 Email Inspection To Facility Operator ❑E Inspection Form Number: IW -1049547 <br />electronic survey <br />* TPID - Site Suffix: 1849171 - 01 <br />Found in Database <br />Jose Tire <br />619 North Sacramento Street <br />Lodi, CA 95240 <br />Local Identifier: San Joaquin County <br />Business Rep: Jose Flores Title: Owner <br />* 0 Tire Count: 15 <br />Latitude: o Longitude: o <br />* Inspection Type: / Routine Re -inspection Referral Observation Educational <br />If referral, referral type: CHP CalRecycle Complaint Other <br />Inspected By: 39-101 San Joaquin County V <br />* Inspector: Ben Escotto v <br />* Inspection Date: 1/17/2017 <br />* Time In 10:45 AM <br />* Time Out 11:15 AM . <br />* Operation Status Tire Type Business Role Storage Type <br />Active V Passenger V Generator Outdoor <br />Closed Altered Hauler Indoor <br />Inactive <br />Planned Truck End -Use Container <br />OTR <br />Business Type: <br />New Tire Dealer Auto Body Agriculture Retreader <br />./ Used Tire Dealer Hauler Government Crumb Rubber <br />Service Station ,._i Trucking Fleet Collection Dismantler <br />Auto Repair Car Dealer Shredder Tire Derived Fuel <br />Other Business Type Other: <br />Part B - Inspection of Waste Tire Dealer, Generator, and End -Use Facility <br />https://secure.calrecycle.ca.gov/WTMS/Inspection/Survey.aspx?SurveyID=244765&Orga... 1/23/2017 <br />