Laserfiche WebLink
Waste fire ourvey (RA InspecUon Repuu i Inspection Report Number <br />CalRecycle State of California <br />CalRecycle 181 (Rev. SU peForm <br />o Page <br />11 1245171 <br />Dept. of Resources Recycling and Recovery calRecycle) <br />Sart A - Survey BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID -� �y � q � � - � ` Inspection Type (Fill one) <br />Site Suffix: ` ` i I O Routine 0 Re -inspection 0 Referral 0 Observation <br />Local <br />Identifier: �51 ki Jba4 ()'0 <br />Business or Facility Name <br />Physical Address <br />Nowl <br />SbCVr <br />Busin <br />essRepRep % / ��// <br />UJ L iii!- /' <br />Tire Count (1A/l <br />GPS Latitude <br />Longitude <br />Business Type (Fill all that apply) <br />0 New Tire Dealer 0 Auto Repair <br />0 Used Tire Dealer 0 Auto Body <br />0 Service Station 0 Hauler <br />Title <br />s � <br />I♦ Trucking Fleet <br />0 Car Dealer <br />0 Agriculture <br />If Referral, choose referral type (Fill one) <br />0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br />Inspected By Inspector <br />Inspection Date 1 V / <br />//YdK <br />Time In <br />A <br />0 AM <br />0 <br />0 PM <br />-Operational Status <br />Tire Type <br />0 <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />0 <br />(Fill one only) <br />(Fill all that apple <br />l/ <br />0 Active <br />0 Closed <br />0 Passenger <br />0 Altered <br />0 <br />0 <br />0 Inactive <br />0 Truck <br />O <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />0 <br />0 <br />0 Planned <br />0 OTR <br />U Government U Retreader <br />0 Collection 0 Crumb Rubber <br />0 Shredder 0 Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />0 <br />0 <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />0 <br />0 <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />0 <br />0 <br />PRC § 42956 - Registration/Decal in Vehicle <br />0 <br />0 <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />0 <br />0 <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />0 <br />0 <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />0 <br />0 <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />0 <br />0 <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />0 <br />0 <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />0 <br />0 <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />0.0 <br />Other: § <br />pp <br />Comments D- . - %- .L---4- .._ -, ,. a� .. �X �_ � _,._ <br />M <br />i 1� / I ��_ <br />Time Out <br />3 ,AM <br />0 PM <br />Business Role Storage Type <br />(Fill all that apply) (Fill all that apply) <br />0 Generator 0 Outdoor <br />0 Hauler 10 Indoor <br />0 End -Use 10 Container <br />Dismantler ( ) Tire Derived Fuel <br />ENFORCEMENT STATUS <br />0 Notice Of Violation 0 Extension <br />Compliance Deadline <br />Date 1-11 / m / m <br />(Required for NOV or EXT) <br />0 Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />Inspection Form Included: U <br />R1-5 11b oyb(40-7) 410 Zo <br />Comments Included: <br />Business Rep's Signature Phone N her Inspect 's Sign ure Phone Number <br />---62081 <br />INSTRUCTIONS ON BACK I Correct:* Incorrect: El 111213 <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA ® ■ <br />N <br />f <br />W <br />