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HAULER OBSERVATION REPORT <br />Ca1Rec cle State ofCa5fornii <br />Y CalRecycle xxx (Rev rant) <br />rep. of Rn Rwyclina and Rmowy <br />F �jdf •j,�. a : t r �:c Rr <br />O TPID -not available/not applicable <br />TPID - % (� 0 1 E-( C <br />Vehicle State <br />Plate <br />Decal <br />Number <br />(If Applicable) <br />Q Hauler Exempt: <br />Hauler Name <br />Hau r ddress <br />13� A-ew PC7-1'} . )c- <br />Street <br />(laic O CXR <br />City State <br />Driver's Name <br />Location of Observation <br />698' -:FmvncvT�- <br />Street <br />S -f CA <br />City State <br />cl' 1.303 <br />Zip Code <br />D.O.B. <br />q5;t6s— <br />Zip Code <br />TiresLtiad`CaU(tt p: _ <br />used + waste) <br />Part B - <br />Observation Report Number <br />iH - XXXXXxx <br />BLUE OR BLACK INK PEN <br />Observation during inspection at: <br />llp Generator 0 End -Use Facility 0 Other: <br />TPID = I l b 1 7 1 Q 1 7-7 <br />Q Observation in transit <br />Observation by Inspector <br />Observation Date <br />Observation Time <br />• E77 O AM <br />7� D ® PM <br />For more information concerning Waste/Used Tire <br />Hauling & Manifesting, please call the Waste Tire <br />Hotline at (866) 896-0600. <br />O <br />O <br />PRC § 42951 -Waste Tire Hauler Registration and Transport of Tires <br />O <br />O <br />PRC § 42958 (c) - Failure to Present Registration to Official <br />O <br />O <br />PRC §42952(b) -Falsely Represents Self as Registered Hauler <br />O <br />O <br />14 CCR § 18456.4 —Failure to Abide by Temporary Registration <br />O <br />O <br />PRC § 42956 (a) - RegistrationlDecal in Vehicle <br />O <br />® <br />14 CCR § 18459 -Hauler Complying with Manifesting Requirements <br />O <br />O <br />PRC § 42956 (b) -Hauler Using an Unregistered Vehicle <br />Q <br />® <br />Other § /V c'L_ie j CYLf 6 C_ , C k ) <br />Comments I Driver's Statement: <br />►�� - <br />--p-�t._,__�n.__ <br />r f <br />Comment Form, <br />Photos p z.� t tyre <br />Dr{yer' Signature Phone iVurttbe s s ,r�gf red <br />