Laserfiche WebLink
Waste Tire L.Arvey & Inspection Repo. . Inspection Report Number ■ <br /> CalRecycle State of California I 1 - 1178047 <br /> CalRecycle 181(Rev.10/10) 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- r_ r^� ^r� 11 Inspection Type(Fill one) <br /> Site Suffix: l9 `/ d, tk 0O Routine Q Re-inspection Q Referral Q Observation <br /> Local \ /'�� � If Referral,choose referral type(Fill one) <br /> Identifier. SG,(��� �1 n O CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> Physical Address ` O 1 C S <br /> Iwo w - cAt., (zA - <br /> Inspection Date 5 / � '9 / <br /> Time In Time Out <br /> Business Rep Title � : � 5 0 AM 3 0 AM <br /> 1 <br /> • PM 5 ® PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) <br /> t ' (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Q Active • Passenger ® Generator ® Outdoor <br /> o Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O 6 Inactive •Truck <br /> Longitude — Q Planned O OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q 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 • Other Ft4f <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 <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> O Q PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or E.Y7) <br /> a <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> W <br /> O Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> Q 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 Q.b11 1 r\-L kA" 6\S <br /> ZhMOr11S <br /> / ) \ p�, y <br /> 01 real ll� n. <br /> Qrc?erq I►we_utfv N-1,'s hn!� <br /> Inspection Form Included: Q <br /> Comments Includde �C <br /> 8. � Business Rep's Signature Phone Number Insp tor's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: � W I I E I X I A IMI P L I E JZJ 11213 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink CopyV <br /> ® 0 <br />