Laserfiche WebLink
0 Waste Tire Survey & Inspection Report Inspection Report Number . <br /> DdRecycie state a1 oallfernia 11 - 1210114 <br /> CalRecycle 181(Rev.10/10) Survey Form w Page 1 <br /> Dept.of Raeourcee Recycling and Recovery(CalRocycla) <br /> _ Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> Site Suffix: 6It <br /> FOE( 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local ( / ( If Referral,choose referral type(Fill one) <br /> Identifier: JOCC� �� 60L yl, Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> `Phys ca�ss' ��iS .j A.R -6 L1^,,-q______1 <br /> s- � - <br /> Slreet / <br /> Inspection Date <br /> C' State ZIP Code <br /> �PCo� Time In Time Out <br /> City <br /> Business Rep 0 AM 0 AM <br /> Title 0� E51 : <br /> O ®PM ® - N O o PM <br /> �� ���— J E�`�__ �J Operational Status TireType Business Role Storage Type <br /> ('� ^ I (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count(Whole/PTE) <br /> J70 Active 0 Passenger ® Generator ®Outdoor <br /> ®Closed Q Altered <br /> GPS Latitude �, Q Hauler Q Indoor <br /> O QInactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> 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 L <br /> Part B- Inspection of Waste Tire Dealer,Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A I HAULING AND MANIFEST REQUIREMENTS <br /> Q Notice of Violation Q Extension <br /> Q O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal it Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements DateM , M / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EX-0 <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators (�In Compliance-No Violations o <br /> Q Q Other:§ 1 <br /> Commentsn/� <br /> Pf �'1re- e121�— QLz�r_rY11�[>01 T, 3—C�=-fit' <br /> �Q j c_'-�_►?_a_�c� . n1o�a —C�'rias2 __ �► �1—,�_�l.o_11Qn��o�%�_ -o..fi- ��S <br /> s __ -_►�c -c�ee rte., �t_Y ,r ��rte_ k��- U�-ct4_,,._t0yW e) ° -- <br /> I Arcoy-n <br /> Inspection Form Included: Q � <br /> r Comments Included: Q ` <br /> -v - �,a�� 0 �`� -Yf� -76Business Rep's Signature Phone Number. In pe o Si ature Phone Number <br /> INSTRUCTIONS ON BACK Correc Incorrect: E XjA' j#jPfLjEj 1112F3] 62081 <br /> White Copy:C Rec Yellow Copy:Operator Pink Copy:LEA ® ■ <br />