Laserfiche WebLink
Waste Tire c' itey & Inspection Repol, inspection Report Number <br /> Cal Recycle State of California I 1 — 1 1 7 6 5 5 / <br /> CalRecycle 181(Rev. ( o) Survey Form - Page 1 �- <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> 3 Z <br /> Site Suffix: ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: -� V` Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Nam Inspected By Inspector <br /> CL'C'�-o( C� <br /> Physical Address <br /> s� 3 Cilt � <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title ® AM Q AM <br /> O PM '�` 0 ® PM <br /> �rilvLll7ffTL_ _ �� Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ' 9 / ® Active Q Passenger # Generator ® Outdoor <br /> o Q Closed Q Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> 0 Q Inactive ® Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair ® 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 B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> - - -- -- --- Q Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> (Required for NOV or EX7) <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days N <br /> r <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <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 w <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> In Compliance-No Violations o <br /> Q 1 Q 1Other:§ - - <br /> Comments <br /> ?�L�lYL e� %n�J�=�'�3----�=^ �i� ���GL/1_l�l-- i�✓1iC y-."�Li/'�.ls�_/22_Gj .., <br /> 14 <br /> Inspection Form Included: Q X <br /> Comments Included: 41 <br /> ® — `il � <br /> Busines 's S' ature Phone Number spector's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: � �J E X A M L 1 ; 2 <br /> 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink C-A"qv <br />