Laserfiche WebLink
Waste Tire Su,vey & Inspection Report Inspection Report Number <br /> State of California <br /> CalRecycle I 1 - 1196287 <br /> CalRecycle 181(Rev. (Cal 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- Inspection Type(Fill one) <br /> Site Suffix: 2. 1* Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: SQh 'TG 4Iy� COV,n O CHP Q CalRecycle O Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> 1 Igvxddi l��\�s0.�� 'oo�.S,��c. - 1 O 1 A <br /> Inspection Date O <br /> rC Time In Time Out <br /> 111 <br /> Business Rep Title O AM O AM <br /> \ �� � O 0 PM 2 � � 0 PM <br /> `rvbwAs �• So0.0.CO 7//e�n;bc ViC2� <br /> 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 ail that apply) <br /> ` 0 Active Q Passenger 0 Generator Q Outdoor <br /> Q Closed O Altered <br /> GPS Latitude Q Hauler 0 Indoor <br /> O Q Inactive 9 Truck <br /> Longitude - Q Planned 0 OTR O End-Use O Container <br /> Business Type(Fill all that apply) 11 <br /> Q New Tire Dealer Q Auto Repair 0 Trucking Fleet Q Government Q Retreader 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 4j Other <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 /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> O O PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> O O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> O Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> Other:§ <br /> Comments <br /> Ac. <br /> c S <br /> Inspection Form Included: Q <br /> Comments Included: <br /> u ' 's Signature Phone Number Inspector s Signature Phone Number <br /> INSTRUCTIO ON A Correct: Incorrect: E X A M P L E 1112 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA © ■ <br />