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HAULER OBSERVATION REPORT Observation Report Number <br /> e <br /> CalRec clState ofcatifomia IH— XX <br /> Y caw—ycle xxx(-�> <br /> D•raBLUE OR BLACK INK PEN <br /> t tt�!3 .• l�w��I +s aE` 9` i� `Jf f s ert� l`�f'� <br /> O TPID-not availabletnot applicableT <br /> � Observation during inspection at 6�s� l rQ�SebC <br /> (j 9 Generator p End-Use Facility p Other. <br /> TPID- I Q O <br /> Vehicle State IPID <br /> Q <br /> Plate Observation in transit <br /> Decal Observation by Inspector <br /> N�w�S a>� 3 °� loll M NT`f <br /> Observation Date 1 3 <br /> Q Hauler Exempt <br /> Hauler Name ` Observation Time <br /> kx?c�`�%cam (,ov►� v��/��hC, `J. I ►�♦ �w <br /> Hauler Address ! �' �• O PM <br /> Street <br /> S Gk�Ovl CA 9S ZC6 <br /> City State Zip Code <br /> Driver's Name D.O.B. <br /> Location of Observation �. <br /> n 644 S•Tr7�r,Gy.. 'Bw <br /> Street <br /> T Ca XY cA 'IS 377 • For more information concerning Waste/Used Tire <br /> city state Zip code .Hauling&Manifesting,please call the Waste Tire <br /> Hotline at(866) 896-0600. <br /> Part B- <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport of Tires O © PRC§42956(c)-Failure to Present Registration to Otfclal <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler Q Q 14 CCR§.18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle Q 0 Other§ <br /> Comments 1 Driver's Statement: <br /> D�c�r�_.Lb._.Ss'a_�ne.�S.��.s>`�...A�S'�i__S�•r.� ".i$1°I -'o�c�_�-5�2?�__-__— . <br /> �CQrAeY� <br /> Gv�c �'__h�_ ' <br /> 'r_ i::. •kP ' SU a, a ' { ' i. F 1 aF t a y3 iv . ' a � NAMP �rai A �i_ <br /> illMe <br /> .. 011 <br /> t "1 {'; i1Q' s � I7A�L °• .?i }'ffiidC rid y lxh t` pS 'hQ <br /> p`ri eri 4gna te* ; Y P o f e N e �l C <br /> ..1 �i.... ;-f+. r' "'?;S�<...+5'�,.. <br /> Correct: Incorrect: M a o <br />