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05/15/2013 03: 57 FAX 2098247493 MANTECA QUALITY AUTO SAL Q002 <br /> � Oa Waste Tire Survey & Inspection Report -Inspetaion Rep <br /> ort Number <br /> CalRecycle State of California I1 1 I T7 C 3 3 <br /> Cale,6,(Rev.10/10) Survey Form - Page 1 _.i. <br /> Dept.of Resources Recyclingycling and Recovery(CalRecyclei - <br /> Part A- Survey - BLUE OR BLACK INK PEN <br /> Business"file Insperrtlon Detail <br /> TPID- Inspection Type(Fill one <br /> Site SUM*: L � � �� S 0 I I Q Routine • Re-Inspection .Q Referral Q Observation <br /> Local <br /> If Referral,choose referral type(Fill one) <br /> Identifier: O CHP Q CalRecycle QComplaint Q Educational Visit.Q Other <br /> Business or Facility Name �• Inspected BY Inspector <br /> P <br /> Physical Addnsss ;0 , <br /> Inspection Date 1 , ^� 1 <br /> /Y i G'1..Ae-[..C.,... .... .:. ... ....y �/ Time In Time Out <br /> .... <br /> -.- <br /> AM <br /> Business Rep Title _ - O AM I.2 I . O <br /> QPM I.... . .� ; QPM <br /> T Business Role <br /> i tr, ifs` <br /> Operational Status Titt9fiype <br /> (Fill one only) (Fill dill 1h4.appi.o (Fillall that apply) i > <br /> "all"°�ih[�fe Active pati 6r Generator <br /> ® .. <br /> Q Closed 0` kefEd t <br /> GPS Latitude _. ..... <br /> O Hauler <br /> o QInactroe Truck <br /> - QQ�6 <br /> Longitude Q Planned QOTR End Use >�c�snt}1 <br /> a <br /> �- _ ;•.O - Q - 0 <br /> ........_ <br /> O <br /> ® New Tire Dealer Auto Repair Trucking OMeet Government Retreader Dismantler Tire Derived Fuel <br /> Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder O Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility . ENFORCEMENT ST4.r <br /> .....—.�__ .... - — - _._.. ..—.._._..__. . - — <br /> V; A HAULING AND MANIFEST REQUIREMENTS Q Notice i3f Violas on O EiRerraion <br /> _ —.---_ - <br /> 5 O PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> O O PRC§42956-Registration/Decal in Vehicle <br /> 0 O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 0. 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 (Acquired for NOV or FX7) <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> O .0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 0 14 CCR§19462-Manifest System Requirements for Tire Dealers or Waste Tire Generators Olri.bompliance No Vlolatione.- <br /> O Q Other:§ <br /> — <br /> Comments e) ,n> r ova � In,Q-__.Cir - A�Q O h <br /> 1� Ice.N c <br /> r' <br /> • <br /> Inspection Form Included< <br /> Comments Included.' - <br /> �'�.�' <br /> Sign hone Number nspe is SI nature �^_ Flhione f jtamefr ;. <br /> -•--_- ---- _ _ _._ —.._ 62081 <br /> INSTRUCTIONS ON BACK Gorr t: ncorrect ( E X AMPLE 1 2 3 ` <br /> Cr^ •11 110r••cl^ V.11^w Copy:Operator Pink Copy:LEA <br /> Received Time May. 15. 2013 2. 49PM No, 0639 <br />