Laserfiche WebLink
Waste Tire S, red & Inspection Repor' Inspection Report Number ■ <br /> CalRecycle State of California I 1 - 1177532 <br /> CalRecycle 181(Rev.10/10) SurVe�� Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> - BLUE OR BLACK INK PEN <br /> Part A-Survey <br /> Business Profile Inspection Details <br /> TPID- L Inspection Type(Fill one) <br /> Site Suffix: 3 V > , 10 Routine Q Re-inspection O Referral Q Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> d� <br /> Identifier: V%✓ Cp V✓l Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> lel _ <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address <br /> 23S �• Cicc���S c`v2. _ <br /> \\ 2 Inspection Date 3 / 1 LA 3 <br /> 5 �C�C�T01n �� 5Zo3 TimeOutTime In <br /> Business Rep Title 2 y 5 0 AM 0 AM <br /> 0 PM 3 ' 5 e PM <br /> - Operational Status Tire Type Business Role Storage Type <br /> 5 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count (Whole/PTE) <br /> ® Active 0 Passenger 0 Generator Q Outdoor <br /> O Q Closed O Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> o Q Inactive 0 Truck <br /> Longitude - Q Planned 0 OTR 0 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 0 Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Other �VVnks- l0.(- <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS Q Notice Of Violation 0 Extension <br /> Q O PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q O PRC§42956-Registration/Decal in Vehicle <br /> Q O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m m N <br /> O O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> (Required for NOV or EX7) e4 <br /> 0 O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days ti <br /> Q O 14 CCR§18459.3-Retention-of Comprehensive Trip Logs for 3 years o <br /> Q Referred/CalRecycle Enforcement <br /> Q O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 2 <br /> w <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities - <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> 1010 Other:§ z <br /> Comments1�SE)ec -�zb� l !!t $ A=Ae <br /> a p'r Ace&5 d co v"ce rn <br /> p u <br /> Inspection Form Included: O / �- 6 0—'5Zf4 <br /> � 2o9-M <br /> Comments Included: 0 — <br /> B siness Rep's Signature Phone Number _Inspe or's Signature Phone Number <br /> —" 62081 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: � EXAMPLE 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />