Laserfiche WebLink
Waste Tire St., Vey & Inspection Report Inspection Report Number <br /> State of California <br /> CalRecycle 11 - 1210362 <br /> CalRecycle 181(Rev. (Ca Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK_ PEN_ <br /> Business Profile Inspection Details <br /> TPID- . 0_ O Inspection Type(Fill one) <br /> Site Suffix: (7 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local / If Referral,choose referral type(Fill one) <br /> Identifier: <br /> 70.v� Jon>V t r1 Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> 12bvti� J A <br /> Physical Address <br /> .z s S 3 3 N, -- <br /> Inspection Date 1 3 <br /> C�v��e C�c q s 2Zd <br /> Time In Time Out <br /> Business Rep Title AM ® AM <br /> 1 5 0P 0P <br /> �l�►-S� �0 2��2.� ��2 f <br /> Y -- Operational Status Tin:Type Business Role Storage Type <br /> Tire Count (Whole/PTE) u (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> I * Active 0 Passenger 0 Generator 0 Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer * Auto Repair Q Trucking Fleet Q Government Q Retreader Q 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 Q 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 /> Q Notice Of Violation Q Extension <br /> Q Q <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 /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years In <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities u, <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators OIn Compliance-No Violations o <br /> Q Q1 Other:§ <br /> - - Z <br /> Comments <br /> 12..0 v���� wc�� 'ri r2 ��n.5,�s..���c,�n r` v.z r� +r� •s <br /> �r� +�4p�-�ioh•S pr ea.S a �_ C9v���C� <br /> Inspection Form Included: Q Zoq 5wZZ�3 <br /> Comments Included: i� <br /> Busine Rep's Signature Phone Number INy� nspec is Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct: Incorrect: X q EXAMPLE 1 2 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />