Laserfiche WebLink
0 Waste Tire S.__ Bey & Inspection Report Inspection Report Number ■ <br /> CalRecycle State of California 11 - 1177894 <br /> CalRecycle cover (CalRecycle) Survey <br /> Survey Form - Page 1 <br /> Dept of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey <br /> BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection 1 C� (1 - Inspection Type(Fill one) <br /> Site Suffix: 1 t 1 1 l C) 1 ® Routine Q Re-inspection Q Referral Q Observation <br /> Local t / If Referral,choose referral type(Fill one) <br /> Identifier: n J QG(OI )'1 (01A n Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> C' C'* C' A-uktv '�c�nsport <br /> Physical Address q <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title O AM ^ O AM <br /> T'Qf rn_ Cy) C_ <br /> UszO PM ,� PM <br /> t Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) 1 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ' ' 1 ® Active ® Passenger ® Generator S Outdoor <br /> 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 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 � � �(,1 t�(JrA�1 <br /> Part B- Inspection of Waste Tire Dealer,Generator, Hauler and End Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 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 /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m <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 Exr) N <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 W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> Q Q Other:§ <br /> n <br /> Comments {�-OAXI nc' 1 A)[a e. 1,e <br /> No j C,,,nteff)- <br /> Inspection Form Included: 1 _ <br /> Comments Included: ® � 1�� <br /> _ <br /> siness Rep's ignature Phone Number Insp tor's Signature Phone Number <br /> INSTRUCTIONS ON BACK 1 Kcvl <br /> Correct:4D Incorrect: E X A L 1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Co y:I ® ■ <br />