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HAULER OBSERVATION REPORT Observation Report Number <br /> CalRecycle "teof"brd" 5H-X)OCKXXX <br /> upxqcle XNX(Rw <br /> BLUE OR BLACK INK PEN <br /> FE I WE I 0� �,PrW fi V,00-0,;E�2"INIQ'Infto Ml-its VR&IM,ME 10)"W15i t <br /> 0 TPID-notavp'ilable/not applicable <br /> Observation during.-inspection at <br /> TPID- 0 Generator 0 End-Use Facility 0 Other: <br /> _ 14.1 <br /> Ve hicle -7 6 <br /> Plate State 0 Observation in transit <br /> Decal m Observation by Inspector <br /> Number I 1. 1. ITI i F M-k <br /> (KAppOrAble) <br /> Observation Date <br /> 0 Hauler Exempt: • <br /> Hauler Name Observation Time <br /> 0 AN <br /> Hauler Address 0 PM <br /> Street <br /> CA q(l <br /> City state Zip Code <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> 211 <br /> 114 <br /> 67 K�,v 6r- Z,00—y. <br /> Street <br /> e-A5-j-0- & y For more information concerning Waste/Used Tire <br /> City State Zip Code <br /> Hauling&Manifesting,please call the Waste Tire <br /> 4F <br /> ZIA <br /> M 051 Hotline at(866) 896-0600.1. <br /> M 2%11 ni <br /> Part B - <br /> W10"NAM W- 1 <br /> 0 0 PRC§42951-waste Tire Hauler Registration and Transport ofTires 0 0 PRG§42966(6)-Failure to Present Registrafion to Official <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§-18456.4-Failure to Abide by Temporary Registration' <br /> 0 0 PRC§42956(a).-RegistrallorilDecal in Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle a Q Othei§ 6<:11Z) jff-15Q a L <br /> Comments I Driver's statement: <br /> kill/ <br /> IS uy--ve L4 �1� <br /> rx. <br /> jr M- <br /> R., <br /> IL <br /> cemYY) <br /> A <br /> ID1,411,11 <br /> fit li" <br /> e, <br /> FLO <br /> -.&Maw <br /> Correct: incorrect: <br />