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r <br /> HAULER OBSERVATION REPORT <br /> CalRecyCle calRegc a 775(New 2/14) <br /> DcpL or Reaowcea Fecy.14 and Recovery BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> Q TPID-not available/not applicable ® Observation during inspection at: <br /> o Generator O End—Use Facility O Other: <br /> TPID- <br /> Vehicle TPID- ( .:J --J-10 •L <br /> Plate State Q Observation in transit <br /> Decal _ Observation by Inspector <br /> Number <br /> (If upplica- <br /> O Hauler Exempt: Observation Date <br /> Q Hauler name&address not known <br /> Hauler servation Time <br /> Hauler Address <br /> Street �4 ENFORCEMENT STATUS <br /> city State Zip Code O Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> f C1gq jAAc&rj.v �4j4W 0 Referred/CalRecycle, Tire Hauler Compliance Unit <br /> Street <br /> l-�x-f�i vo Cf� ��33Q <br /> -- •-- -- - - --/� --- — --- - - -- - For more information concerning Waste/Used Tire <br /> city State Zip Code Hauling&Manifesting, please call the Waste Tire <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> O O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Official <br /> O Q PRC§42952(b)-Falsely Represents Self as Registered Hauler O Q 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle ® O 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle O Q Other§ <br /> Comments/Driver's Statement: <br /> 6r) 15- CIL rcUA2rlt, "t�4r3 Loan, c c Kka-ChA <br /> F_I eA t— >Q kv i z "f/37t)i 7-7--O ll n. 4is L5 <br /> t k-.5aec-ficn < 7Z` t►Ue w i�ri�(e, ('C�r �xrc� aw �i4312t1-00 <br /> _7.w�rte- o� ✓ s;l-�, '7h e- se_ (Cao c-6-5 CLrPP-ccr <br /> M1 CL 1.1 11'ls C'rtzR, (4r }� 51�r✓i C1a <br /> S0 iK(rh f U /�+" z- bL)-s;.fws_S4,-Cj- <br /> CfC G _ <br /> Comment Form O <br /> Photos ® Driver's Signature Phone Number Inspe, or's Signature Phone Number <br /> Correct: Incorrect: W <br />