Laserfiche WebLink
® Waste Y Ore Suivey & hspscUon Report. Inspection Report Number ■ <br /> CalRecycle State of California g� 1 1 e 1242301 <br /> CalRecycle 181(Rev.y(Co) S ryP vey For o �age `� <br /> Dept.of Resources Recycling and Recovery(CalRecycle) V 6�� C9 Form o t� a �Jj II <br /> mart A-Survey BLUE OR BLACK INK PEN <br /> siness Profile Inspection Details <br /> fPID- I V7 q S 1 l _ © Inspection Type(Fill one) <br /> Site Suffix: 1 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: COI nI 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> G n J (pet', n - _ <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address 0 CS C07 <br /> lp [3 Inspection Date a <br /> �-�on Cf\ lSalS 1 <br /> Time In Time Out <br /> Business'`1Rep e '_ 'z }TitleO AM O AM <br /> (Z n(n J4T ryiI5 W o-Ll nzj- I 3o e PM- 3 6 V ®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 /> ' 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> O 0 Closed 0 Altere�rJ O Nu A 0 Indoor <br /> Ga pS Latitude <br /> O 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> .J Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder ® Other 4� <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle N <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> 0 1 0 1 Other:§ <br /> Comments �,t GI <br /> Y�1�1 <br /> (.t2 n iezn_ <br /> he/1. ,44?nc �U51'ns3 pry 3i <br /> --pection Form Included: 0 <br /> Comments Included: 0 T7-1- M ? + r a 4 I'a <br /> Business Rep's Signature Phone Number Ins ctor's Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: E X A M E 2 13 1 <br /> 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Cop :L ® ■ <br />