Laserfiche WebLink
Waste Tire SL . .tey & Inspection Report inspection Report Number <br /> dal Rec cle State of California <br /> Y CalRecycle 181(Rev.10/10) Survey Form - Page 1 I1 1177862 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` 3 _ Q Inspection Type(Fill one) <br /> Site Suffix: ` 1 * Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: (kn 70 al LA 1 (0,A_A'lty\ Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> dc's s(,�w C"b 3 <br /> Physical Addrress11 1 - l 0 1 �S <br /> �S J LA C, T I to�-c�mcr 1. . <br /> �j GAqSL� Inspection Date Vh (� I 3 <br /> Time In Time Out 1 <br /> Business Rep Title0 AM I O AM <br /> 1 S (,l PM / O ® PM <br /> Operational Status Tire Type Business Role Storage Type <br /> r-� <br /> Tire Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> `f <br /> ® Active 4111 Passenger • Generator ® Outdoor <br /> Q Closed Q Altered <br /> GPS Latitude ® Hauler Q Indoor <br /> O Q Inactive ® Truck <br /> Longitude - Q Planned Q OTR End-Use ® Container <br /> Business Type(Fill all that apply) <br /> S New Tire Dealer Q 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 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 /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <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 EX7) 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 (6 In Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments 1 J l ► A) <br /> UANA S d fha�' <br /> -Fo �► S n 4CA '), <br /> INU X11 tYi3 p1 CAIel�S t [,un�e rr) <br /> Inspection Form Included: 1* 4(e <br /> Comments Included: <br /> Business Rep's Signature Phone Number &Inp t is Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: E X A M L E 112 L3J 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Cop L <br />