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HAULER OBSERVATION REPORT Observation Report Number <br /> CalRec cle scrtrorc,rrr�t�. IH-XXXKXXX <br /> y CarRetycre X700(Rev moc) <br /> Dqt.ax x-Ir-li.X-enemy BLUE OR BLACK INK PEN <br /> sFlau0111"M �1 <br /> 0 TPID-not available/not applicable <br /> ® Observation during inspection at: <br /> TPID- 16 I ,% 13 I S I o- 0 Generator 0 End-Use Facility p Other. <br /> Vehicle TPID:I 1 IS Is 19 I g I , I f <br /> s I_ o <br /> Plate I I I I I I I I State 0 Observation in transit <br /> Decal Observation by Inspector - <br /> Number,�D I. I I I I I QE - I l loll I l Escz©TTO <br /> Observation Date F I O � <br /> 0HaApplicable <br /> uler Exempt: <br /> Hauler Name n L Observation Time <br /> WAM <br /> ti}g v U�a ;1 - r o rc�(�q��r FTI: Jr • <br /> Hauler Address PPµR <br /> y <br /> Street � N�w�lsvn �'�� • t <br /> CityviMJrU/1 State <br /> � �'p C se <br /> O5 <br /> Driver's Name D.O.B. <br /> - 7 <br /> Location of Observation <br /> Street <br /> For more information concerning Waste/Used Tire <br /> city State Zip Code <br /> Hauling_&Manifesting,_pl_e_ase call the Waste Tire <br /> a - �_,: t:• r1 t<r ,arns Hotline at(866) 896-0600. <br /> � Lo,d�'C°�•.. t � ,;ev- I I; ���, �,, ,alt, <br /> Part B- <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires 0 0 PRC§42956(c)-Failure to Present,Registration to official <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 0 PRC§42956(a)-RegistrabonfDecal in Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments 1 Driver's Statement: <br /> _ 94 _Ca].?esu �� [c�k� .._wc,s�� _r in5o,aw�s_I �+ <br /> . 1 „ <br /> eAlk..._Wf%j It ke�wv � C� -!3�1SS�Lj-00� <br /> 11 r ""`1---- <br /> ` t L --- <br /> S�n (v.------ <br /> �.r,1wi bI l;w���inUJo� <br /> o "G�,,�' <br /> Un un.. l�S�.n _ _T.P .__.�3.. 11►�t- ff. was Lvd; �n•_ �z7fL��11__�a1c7�13' ___L?1'' <br /> I'ko�IC�_ ��" S�1of �LN_ 11c�c_ .1 'ss_1J� � <br /> �-� ^' rte.., 1� e x � i veM 3V'" �. �; -- � p '��t;e f�' f���' t y �? •` r t �,r,� s t 'fi'r <br /> r i scar 'tip P! FU ltd - t I,� y14'S5 I <br /> rt tre Hit v i -9 a"t t i <br /> � '�`'�C`�?'.� �I10r)@�IrU��E�r :• <br /> Correct: Incorrect: M a o <br />