Laserfiche WebLink
Waste Tire Su, vey & Inspection ReporP Inspection Report Number <br /> State of California <br /> CalRecycle It - 1230287 <br /> CalRecycle 187(Rev. (cal 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� � ) � � � � � � Inspection Type(Fill one) <br /> Site Suffix: "� Is Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: San 6"LAI A ColA ivlI 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name f Inspected By Inspector <br /> Physical Address 10 1E 00—CTO <br /> atol E . C�nrtirk�r �wJv <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title l l ` *AM SAM <br /> Qcf01 0vjner I " O PM l J v 0 PM <br /> ­ <br /> Operational��� 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 /> ' 0 Active 0 f4sssenger 0 Generator 0 Outdoor <br /> GPS Latitude O 0 Closed 0 Alt/re�11 O / <br /> "1 au e IrK� <br /> 0 0 Inactive 0 Truck <br /> Longitude — 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber I <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder ® ^T Other t ptI Ie/` P <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation 0 Extension <br /> 0 0 <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> M / M / m <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> a <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> 2 <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> 0 0 Other:§ 1 <br /> Comments � h `t"`1'9 tku fnrA <br /> ) <br /> IV d V, a 7S OI U /tet 5 f 'tA, ,,ttM <br /> W 04-- k ��')_ ;1�_5 dr �i Fr�&k 4 is 10y ' low. PSD, <br /> Inspection Form Included: 0 ' <br /> Comments Included: 0 ���1 — U� ,3178 <br /> Business Rep's Signature Phone Number Insp tor's Signature Phone Number <br /> INSTRUCTIONS ON BACK [Correct: Incorrect: X NJ E X A 1112 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pin Co EA © 0 <br />