Laserfiche WebLink
Waste Tire Survey & Inspection Repot 6 Inspection Report Number ■ <br />Cal Recyae State o1 cle 161 (R T 'i <br />CalRecycle 101 (Rev. YOCal Survey Form - Page 1 1 1 <br />-11764-4.1 1 1 % 6 fj /i. 'I <br />f �) !� [i 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Survey <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID - <br />Inspection Type (Fill one) <br />Site Suffix:�''' �^ <br />1 � ?� �} � � � � � <br />Q Routine Q Re -inspection <br />®Referral Q Observation <br />Local <br />Identifier:��(� Je;( 11Y1, Ll�t Yi <br />If Referral, choose referral type (Fill one) <br />Q CHP ® CalRecyde Q Complaint Q Educational Visit Q Other <br />Business or Facility Name <br />- <br />Inspected By <br />Inspector <br />` <br />� C � � � <br />�y <br />Phy 3 C81 Address <br />/ i U t <br />Jg IYLMX> ��iZ{t►( �;i�C-� <br />7CC C <br />Inspection Date <br />Camp C % 4'5R ,7�) <br />Time In <br />Time Out <br />Business Rep Title <br />0 AM <br />® AM <br />r) 0 P <br />( 1 0 P <br />-— --- -- ----- -- - <br />Operational Status Tire Type <br />Business Role Storage Type <br />Tire Count (Whole/PTE) <br />(Fill one only) <br />Q Active <br />(Fill all that apply) <br />I Q Passenger <br />(Fill all that apply) (Fill all that apply) <br />® Generator p Outdoor <br />..............--- _ <br />Latitude O <br />C CPS <br />• Closed <br />I <br />Q Altered <br />N/A <br />I j IVlA <br />Q Hauler ; Q Indoor i <br />O <br />Q Inactive <br />, Q Truck <br />Longitude- Q Planned Q QTR Q End -Use Q Container <br />Business Type (Fill all that apply) <br />............................ _ <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 Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />.............. _ -- - - ---- - <br />V A HAULING AND MANIFEST REQUIREMENTS <br />Q Q PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q Q PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />�Q Q PRC § 42956 - Registration/Decal in Vehicle <br />Q Q 14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q Q 14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q Q 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 i Q 14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q Q 14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q Q 14 CCR § 18462 . Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q Q Other: § <br />Comments <br />ENFORCEMENT STATUS j <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m/m�m <br />R <br />u0 <br />(Required for NOV or EXT) N <br />W <br />Q Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />Inspection Form Included: QI <br />Comments Included: <br />Business Rep's Signature _ Phone Number c r Signature Phone Number <br />62081 <br />INSTRUCTIONS ON BACK Correct:* Incorrect: '+ G7i E X A M, P L E 1 2 3 <br />While Copy: CalRecycle Yellow Copy: Operator fink Copy: LEA <br />