Laserfiche WebLink
Waste Tire &ey & Inspection Repoi Inspection Report Number ■ <br /> Wa 11 - 1226238 <br /> CalReccycleycle181(Rev.10/10) <br /> calRecycle StateCalifornia Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) BLUE OR BLACK INK PEN <br /> Part A-Surve -— - <br /> -- Inspection Details <br /> Business Profile --. <br /> Inspection Type(Fill one) <br /> TPID- ' - Observation <br /> l �� � ® Routine Q Re-inspection Q Referral Q <br /> Site Suffix: _ __ <br /> C If Referral,choose referral type(Fill one) <br /> LocalC �� JAI^ �� Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Identifier: J n <br /> Business or Facility Name <br /> Inspected By Inspector <br /> 3 q - l b I Es zoo <br /> Physical Address <br /> Inspection Date ! / 1 U / <br /> Time In Time Out <br /> Q AM � � O AM <br /> Business Rep Title ® PM 3 0 PM <br /> rTlir'eOCOUnt <br /> kr LLOperational Status Tire Type Business Role Storage Type <br /> 1 (Fill one only) (�il atl that apply) (Fill all that apply) (Fill all that apply(Whole/PTE) , I ll c) ® Active Passenger Generator ® Outdoor <br /> —-- o <br /> ----—— _— Q Closed Altered Q Hauler f Indoor <br /> GPS Latitude O Q Inactive Q Truck <br /> Q End-Use Q Container <br /> Longitude - Q Planned Q OTR <br /> Business Type(Fill all that apply} Q Dismantler 0 Tire Derived Fuel <br /> Q New Tire Dealer ® Auto Repair Q Trucking Fleet Q <br /> Government Q Retreader <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer <br /> 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 JPRC <br /> AULING AND MANIFEST REQUIREMENTS Q Notice Of Violation Q Extension <br /> Q §42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q RC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q RC§42956-Registration/Decal in Vehicle / I <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 (Required for NOV or EXE N <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days <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 <br /> Q Referred/CalRecycle Enforcement 2 <br /> W <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities — <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In compliance-No Violations o <br /> Q Q Other:§ - <br /> Comments <br /> c))J)Cejn <br /> Inspection Form Included: Q �� I0 <br /> 9 <br /> Comments Included: ® Business Rep's Si nature Phone Number Inspe t is Signat e . Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: � � � E X A M E 1 2 3 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Cop L © 0 <br />