Laserfiche WebLink
Waste Tire SL_ jey & Inspection Report Inspection Report Number ■ <br /> CalRecycle State of California 11 - `12 3 0 2 3 9 <br /> Ccyclin andle R cover (Ca[ 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- � O � � ^ Inspection Type(Fill one) <br /> Site Suffix: ) / A Routine Q Re-inspection Q Referral Q Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: 2-a'� �G� �� �v Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> Physical Add s <br /> 3-O 7 c v V� -- <br /> � GC r �G266 I Inspection Date <br /> t+t ` Time In Time Out <br /> Business Rep tle <br /> • ®AM � 5 %AM <br /> V�� _ -ft" <br /> ���-- VC S C� OO PM O PM <br /> perational 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 /> 1' Active Q Passenger i Generator Q Out or <br /> N �K <br /> 0 <br /> (aPS Latitude Q Closed Q Altered <br /> Q Hauler Q Indoor <br /> o Q Inactive Q Truck <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 ��5Tr cu\46 <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 /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> QQ 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / Ffl / <br /> m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EX7) N <br /> _ a <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> E <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 <br /> S In Compliance-No Violations o <br /> Q 1 Q 1 Other:§ <br /> Comments,,- \`a <br /> C1�7� V <br /> bM <br /> Inspection Form Included: Q /�Q G j��� F01-y <br /> 4 <br /> Comments Included: C C D th U / <br /> si ep' Si re Phone Number Inspe or's Signature Phone Number <br /> INSTRUCTIONS O C Correct: Incorrect: X EXAMPLE 1 Z 3 62os1 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />