Laserfiche WebLink
Inspection Report Nulriber <br /> Waste Tire Survey & Inspection ReporL ■ <br /> Cal Recycle State of California l 1 - 1-176773 1-1 7 6 7 7 3 <br /> CalRecycle 181(Rev.y(Ca fl !rjey Forii-n ® Page '1 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) SFA�1 88 `18 i 9 Page`,rJ�i <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ' J C O I C� - © Inspection Type(Fill one) <br /> Site Suffix: 7 l0 71 1 ® Routine Q Re-inspection Q Referral Q Observation <br /> Local 1� If Referral,choose referral type(Fill one) <br /> Identifier: 5 b�'��t n �� ��� Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address s� <br /> co, p C,A �5 S3 Inspection Date <br /> �\ U Time In Time Out <br /> Business Rep t Title 0 AM I 'l 0 AM <br /> ®PM l —v- PM <br /> S�cye P t wnT S. - <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 /> Q Active Q Passenger ® Generator Q Outdoor <br /> O Q Closed Q Altered / •/� <br /> GPS Latitude <br /> O ® Inactive Q Truck Q Hauler Q Indoor <br /> Longitude - Q Planned ® OTR Q 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 Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other fx�-f"p, <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 /> Q Q <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle c <br /> Q 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 /> Q O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> 2 <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments 1 <br /> �_o L <br /> i oz, toe,�iSc. i t15 o.v��i, _ [�11( oj-1 <br /> No 40 w ia() rif-e- ldc nrrn <br /> Inspection Form Included: � <br /> Comments Included: (ib J <br /> ep's Signature Phone Number Inspe t is Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS 0)#K Correct: Incorrect: E X A L 112 3 <br /> ■ Copy:CalRecycle Yellow Copy:Operator Pink Co :L ® ■ <br />