Laserfiche WebLink
Waste Tire Sup vey & Inspection Report Inspection Report Number <br /> State of California <br /> CalRecycle <br /> calRecycle181(Rev.10/10) Survey Fora - Page 1 I1 1177968 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- J - Inspection Type(Fill one) <br /> Site Suffix: ® Routine Q Re-inspection Q Referral Q Observation <br /> Local e 1 If Referral,choose referral type(Fill one) <br /> Identifier: Cin J 6dl,1 u1 r1 C�t� � Q CHP Q CalRecycle Q Complaint 0 Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> 1.x.5 <br /> Physical Address11 l Esso U <br /> 6_NuVVcr <br /> 1 , Inspection Date <br /> ls�oc 04 G 9SLD� <br /> Time In Time Out <br /> Business Rep Title O AM 3 0 0 AM <br /> U L.A�1 1 <br /> � N SANS �- A -n!f) is PM ® PM, <br /> 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 /> ® Active ® Passenger ! Generator o Outdoor <br /> O Q Closed O Altered <br /> G�� Latitude Q Hauler ® Indoor <br /> O Q Inactive 0 Truck <br /> Longitude - Q Planned 0 OTR O End-Use 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 /> 0 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 � Extension <br /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> O O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> O O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EX7) N <br /> v <br /> 0 O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers O Referred/CalRecycle Enforcement <br /> 2 <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> O O Other:§ <br /> Comments <br /> Inspection Form Included: ®' (5Oq 4��^ <br /> Comments Included: Psiness <br /> Rep's Signature Phone Number Insp Dr's Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: E X A M P E 111213 62081 <br /> IMWhite Copy:CalRecycle Yellow Copy:Operator _ Pink Cop :L ® 0 <br />