Laserfiche WebLink
Waste Tire Su.vey & Inspection Report <br />State of California <br />CalRecycle <br />CalRecycle181(Rev.(Cal Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - SurvPv <br />Inspection Report Number ■ <br />I1 -1196279 <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Q <br />Inspection Details <br />Q <br />TPID - <br />Site Suffix: '2> <br />Inspection Type (Fill one) <br />® Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />LocalSr G ILI <br />Identifier: �r%l J <br />" <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q CHP Q CalRecycle Q Complaint <br />Q Educational Visit Q Other <br />Buusinesss or Facility Name <br />Q <br />Inspected By Inspector <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Physal Addroess <br />Q <br />3 - <br />Q <br />�� <br />1 <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />Inspection Date <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Time In <br />Time Out <br />Business Rep Title <br />O AM <br />O AM <br />I <br />0 PM <br />® PM <br />- - - <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)(Fill <br />_41_�L <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />Q Active <br />QPassyrlger <br />@ Generator <br />Q Outd000r <br />Latitude <br />GiP$ <br />® Closed <br />Q Altered <br />Q Hauler <br />/ <br />Q Indoor <br />O <br />Q Inactive <br />Q Truck <br />Longitude - <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair Q Trucking Fleet <br />Q Government Q Retreader ® Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V A I HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Other: § <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />* In Compliance - No Violations <br />i lily' �_-.�� _ _ti L a 'r r �l�i.f /Lt <br />Inspection Form Included: UI <br />Comments Included: U <br />Business Rep's Signature Phone Number 1 e <br />INSTRUCTIONS ON BACK Correct:0 Incorrect: g E X � <br />White Copy: CalRecycle Yellow Copy: Operator Pink <br />Phone Number <br />62081 <br />® ■ <br />a <br />N <br />V <br />N <br />0 <br />W <br />0 <br />