Laserfiche WebLink
Waste Tire Su. ✓ey & Inspection Repon inspection Report Number <br /> CalRecycle state of California 11 - 1177846 <br /> Ccyclin and R cover (CalRecycle) Survey <br /> 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 /> O <br /> Site Suffix: �J• ® Routine 0 Re-inspection Q Referral Q Observation <br /> Local t If Referral,choose referral type(Fill one) <br /> Identifier: Isom Joaq ui n (ov.'nV 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name / %, 1 Inspected By Inspector <br /> Physical A dress `�O�(A'� 1 V171Gr TC,"—,P3 I - ! n I l—.s <br /> J <br /> 3�11�b <br /> N4 (2�A . <br /> —T`cx <br /> Inspection Date � / � � / I 3 <br /> �fl ati� <br /> Time In Time Out <br /> Business Rep Title c O 0 AM 0 AM <br /> J ® PM O 0 PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) (� (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> e Q Active Q Passenger Q Generator Q Outdoor <br /> Latitude o 0 Closed 0 Altered N IA <br /> GPS 0 Hauler O Indoor <br /> o Q Inactive Q Truck <br /> Longitude - O Planned 0 OTR O End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body ® Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 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 /> O 0 PRC§42951 -Waste Tire Hauler.Registration and Transport of Tires Notice of Violation Extension <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> Q 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE n <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> Q O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities _ W <br /> Q O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> in Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments r7__ trk4" <br /> bi fAlet,t U_� (or1Cesn - <br /> 1 See,o1a Z'I- <br /> Inspection Form Includ . O <br /> Comments Inclu <br /> Business ep ature Phone Number Ins toy's signature Phone Number <br /> INSTRUCTIONS ON BACK [Correct. Incorrect: EXAMPLE 1 2. 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />