Laserfiche WebLink
Waste Tire Sua Jey & Inspection Report inspection Report Number ■ <br /> CalRecycle State of California I 1 - 1196565 <br /> CalRecycle 181(Rev. (cal 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 � Inspection Type(Fill one) <br /> Site Suffix: ` 1 0 Routine Q Re-inspection Q Referral Q Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: Sqr �G 0.q V Co Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name II Inspected By Inspector <br /> Physical Address 3 '�A^ _ 1 � 0 A l I <br /> � <br /> A. <br /> 7 Inspection Date � 1 / (3 3 / I 9 <br /> S�OC� `"�� � <br /> V\ � G� Time In b Time Out <br /> Business Rep Title <br /> \ i SAM 0 AM <br /> �b1.r ` et•OS� ���•�, IY►Ol. e.,` ` QPM 1 � © 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 /> ' ' L 10 Active Q Passenger 0 Generator 0 Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive a Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair 0 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 /> PRC§42956-Registration/Decal in Vehicle <br /> QQ 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <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 EXT) <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Uj <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 Sp �1+��� <br /> -- cl �ol�x�s.�yU Cit t C�Y�GcC� <br /> Inspection Form Included: Q <br /> Comments Included: ,* <br /> Business Rep's Signature Phone Nu her Inspector's SignaturePhone Number <br /> -47 - <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: X V]jjj [ jjjMjPLE1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LFA <br />