Laserfiche WebLink
Waste Tire SL Jey & Inspection Report Inspection Report Number <br /> CalRecycle State of California I 1 1229915 <br /> CalRecycle 181(Rev. (CalRecycle) Survey <br /> 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- _7 � _7 Z5 1 _ o ^ Inspection Type(Fill one) <br /> Site Suffix: ` l Q Routine .Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: V�Y-� WV� O CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name ` , <br /> Inspected By Inspector <br /> CO res - 3 <br /> Physical Address <br /> y21 (;C_1A LY\ <br /> s�G��� �� �� Inspection Date <br /> Time In Time Out <br /> Business Rep Title k <br /> y O AM 40 AM <br /> O PM ' O PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> lI* Active 0 Passenger 40 Generator O Outdoor <br /> O Q Closed O Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O Q Inactive Q Truck <br /> Longitude - Q Planned O OTR O End-Use O Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet 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 O 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 Q Extension <br /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle m <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> O O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> O O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE <br /> O Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 <br /> Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> O Q 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 O In Compliance-No Violations <br /> O O Other:§ <br /> Comments yNne r_o V\ 6nn&A- , a,\ 56OAtCA <br /> Qcev o-s5 \j�O�a�t tov� ocS CX 6,t:t yn Cb cC'tC c <br /> Inspection Form Included. Q �Phone <br /> Comments Included. ZO ZSZ— Z7U0Business Rep's Signature Phone Number Inspe or's Signature �Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: M l EXAMPLE 112 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />