Laserfiche WebLink
M Waste Tire SL ;y & Inspection Reporftpection Report Number ■ <br /> Cal Recycle State of California 11 - 1176529 <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- i ( �, Inspection Type(Fill one) <br /> Site Suffix: L4 O I ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: 19CAN, ,-jp y\ Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business <br /> —o-r7Facility <br /> �Name 1 Inspected By Inspector <br /> 1 Vit �t•yV 10�, <br /> Physical Address <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title ] ®AM J O AM <br /> ` O Q PM I a d PM <br /> vi Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) 2 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ® Active ® Passenger ® Generator Q Outdoor <br /> 0 Q Closed Q Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> 0 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 F­A—j HAULING AND MANIFEST` 96l,JWEN"TS <br /> -- -- - - - Q Notice Of Violation Q Extension <br /> Q Q 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 <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle N <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <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 _____ ,-_- W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators .In Compliance-No Violations <br /> Q Q Other:§ <br /> Comments aIn-.4 L in S r]AtA- Q•V1a- T &a& <br /> 14 It <br /> Inspection Form Included: Q 044 1 #V- <br /> Comments Included: ® - —- Vt.�_OG Z <br /> Business Rep's Signatu Phone Number nspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK [Correct. Incorrect: EXAM L E 2.] 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy LEA <br />