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Survey & Inspection Report *vey Form (Page 1) • 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 0 Inspection <br />Form Number: IW -1049544 <br />electronic survey <br />* TPID - Site Suffix: 1750838 - 01 <br />Found in Database <br />PAZ Tire Shop <br />625 N Sacramento St <br />Lodi, CA 95240-1257 <br />Local Identifier: San Joaquin County <br />Business Rep: Javier Gonzales Title: Owner <br />* M Tire Count: 0 <br />Latitude: Longitude: <br />o <br />* Inspection Type: / Routine Re -inspection Referral Observation <br />Educational <br />If referral, referral type: CHP CalRecycle Complaint Other <br />Inspected By: 9-101 San Joaquin County <br />* Inspector: gen 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 <br />Storage Type <br />Active Passenger Generator <br />Outdoor <br />Closed Altered Hauler <br />Indoor <br />Inactive <br />Planned Truck End -Use <br />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 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/InspectionISurvey.aspx?SurveyID=244762&0rga... 1/23/2017 <br />