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............... <br /> HAULER OBSERVATION REPORT <br /> 1,1e olllil <br /> CalRecycle CalRecyce 775m(New 2/14) <br /> Dcpt.d Rasourccr Receding and Recd" BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> • TPID-not available/not applicable <br /> 9 Observation during inspection at: <br /> TPID- <br /> _� A Generator 0 End—Use Facility 0 Other:Vehicle State TPID- f :�, 'j y 1114 3]_ Q <br /> Plate 9 C �' O l 5 )a 0 Observation in transit <br /> Decal Observation by Inspector <br /> Number m 3 9 1 l l &n ESC.AO <br /> (If Applica- <br /> 0 Hauler Exempt: Observation Date F -21/ <br /> 0 Hauler name&address not known <br /> Hauler M -1 . I_ r^ I � Observation Time <br /> mOC�C.4b 5w)n . LC�.0 �nC , ' l l S 4 AM <br /> Hauler Address 0 PM <br /> StreetENFORCEMENT STATUS <br /> I'las <br /> City State Zip Code 0 Notice of Violation <br /> 0 o fel", u C q 53 51,E <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> C �tc��1G ® Referred/CalRecycle, Tire Hauler Compliance Unit <br /> Street <br /> u e(,OU.u\-\ <br /> For more information concerning Waste/Used Tire <br /> city �o�O^ CA State i,a,l s g g,PpCode Hauling&Manifesting, lease call the Waste Tire <br /> Tire Load Count ❑ g O Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires O 0 PRC§42956(c)-Failure to Present Registration to Official <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 0 PRC§42956(a)-Registration/Decal in Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments/Driver's Statement: <br /> -- D Uu nt- W c_ i nsCD,e Qn i pz,s jw_,A_Io � !. G ��c� Pi11= )117411A3-01) <br /> = X33 t Sew w h S v� c� °t si„ <br /> �- <br /> �� M L 1 1 <br /> L� SC V�e (vS( '�1 oC1S f�l ft�� C 1 u7 _ I�C S W��u� <br /> &u ��o, C� 53 5 �-�or 5c.r(A j'maa l <br /> 3J1`SLi0( ��a K "I YW�,`Io (..A <br /> � I/1l� \In C�r�� L j f) �Vt P1�C1 Tl C S (!j lC'� o Y1j,j r'._L()[r_TJ l u1 C_ --- <br /> --- <br /> _�o u 11 A-,jc 4e-A t`1\�'L�n. w S t. Oklor T10_ ---- <br /> Comment Form <br /> Qm� L4c, <br /> Photos ® Driver's Signature Phone Number InsVector's.Signature Phone Number <br /> Correct : Incorrect: X <br />