Laserfiche WebLink
0 Waste Tire SOvey & Inspection Repor. <br />CalRecycle State of California <br />CalRecycle 181 (Rev. 10/10) <br />y(Cal Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Survev <br />Inspection Report Number <br />I1 - 1255922 <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID -I s Q �j Q i <br />p <br />Inspection Type (Fill one) <br />Site Suffix: <br />0 Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Local _ <br />Identifier: `- CL 0 c(^/( LVL <br />Business or Facility Name <br />76t <br />Inspected By Inspector <br />-z— —t / 2 <br />n�� <br />Physical Address <br />- , S/�'�vi�c�i�K4�V <br />U215- ►U . 5cit_Gy-aLvy i,• 5-�-yu — <br />Inspection Date <br />Time In Time Out <br />Business Rep Title <br />O AM j O AM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE) l L(� <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />® Active <br />0 Closed <br />• Passenger <br />Q Altered <br />0 Generator <br />Q Hauler <br />Q Outdoor <br />Q Indoor <br />GPS Latitude <br />Q Inactive <br />Q Truck <br />O <br />Longitude — <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q 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 Q Other <br />Part <br />B - <br />Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />ENFORCEMENT STATUS <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q Notice Of Violation Q Extension <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Compliance Deadline <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Date m <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />(Required for NOV or EX7) <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q Referred / CalRecycle Enforcement <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />In Compliance - No Violations <br />Q <br />1 Q <br />Other: § <br />Comments <br />j7,� ,�� .Lz .��•�+ .(,,G-I,� �lt.-Q.� <br />� <br />1- G(.�1 �C� <br />ILP <br />Inspection Form Included: Q <br />/ r ZZ (7� I U" — <br />Comments Included: <br />Business Rep's Signature Phone Number Inspe is Sigiliguie Phone Number <br />INSTRUCTIONS ON BACK [Correct: Incorrect: E X A M P L E 1 2 3 62081 <br />White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA <br />9 <br />N <br />0 <br />W <br />