Laserfiche WebLink
0 Waste Tire Su, vey & Inspection Report Inspection Report Number <br /> cal6ec cle State of California _ <br /> Y CalRecycle 181(Rev.10/10) Survey Form - Page 1 11 . 1229912 <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: 1 -I o 01 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier. Sp"^ �q v� �6 V ^�-�p 0 CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name 6 l Inspected By Inspector <br /> Physical Address <br /> C'k (qSZa� Inspection Date O 1 I S 1 S <br /> Time In Time Out <br /> Business Rep Title Q O AM C O AM <br /> L PM ✓ 46 PM <br /> �V �l - -� �� Pr•�.� �� Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) 2 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> J Active 0 Passenger e Generator Outdoor <br /> O Q Closed Q Altered <br /> CaP� Latitude Q Hauler 0 Indoor <br /> o Q Inactive Q Truck <br /> Longitude - Q Planned 0 OTR 0 End-Use Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q 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 0 Agriculture Q Shredder Q 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 /> �Notice Of Violation � Extension <br /> O O <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 /> 0 Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 0 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 EX7) N <br /> 0 O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years � <br /> 0 <br /> 0 O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> 2 <br /> Q O 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 /> O O Other:§ L <br /> Comments .r Ica-s , ;- C �YDS 1 <br /> P-e_OAQ \ "POZ G'y\ A—S <br /> .N� <br /> \S_1 ova- <br /> Inspection Form Included: 0 <br /> Comments Included: <br /> B . ess Rep's Signa&A Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: � � � IEIXIAIMIPILIEI 11 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />