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Observation Report Number <br /> I <br /> or _ HAULER OBSERVATION REPORT IH-XXXXXXX <br /> CalRecycle cam-fele cP— > <br /> nrp.orP=m= Rwr_�sacdxcway BLUE OR BLACK INK PEN <br /> 7� <br /> 14��o"Miflu , T" gN ' �!� r YVNH: [I_ <br /> O TPID-not available/not applicable <br /> . ' Observation during inspection at G"' <br /> TPID- I In If-) 10 18 lo-11 I— n i (� Generator 0 End—Use Facility 0 Other. <br /> Vehicle TPID=I I I i, 11 le-1 I I? I- Q L <br /> Plate I I I I I I I I State to Observation in transit <br /> Decalm _ I I I I I I Observation by ff Inspector <br /> Number �ti — t 1 0 l 1 ML,1 tne:�()LA <br /> (irAFaicable) <br /> Observation Date <br /> Q Hauler Exempt: <br /> Hauler Name Observation Time <br /> Hauler A ress <br /> street <br /> City state Zip Code <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> Street <br /> For more information concerning Waste/Used Tire <br /> city state Zip code Hauling&Manifesting,please call the Waste Tire <br /> Hotline at(866) 896-0600. <br /> r 1` <br /> F l i <br /> Part B - _moo <br /> 414;wo 1 211559 <br /> Q Q PRC§42951-waste Tire Hauler Registration and Transport of Tres O © PRC§42956(a)-Failure to Present Registration to Official <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 Q 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehide Q G 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle • 0 Other§ CC1S 5 125LIS1 -- l C.-) <br /> Comments/Driver's Statement: <br /> �v.��� _-- ---_�v_l�l'�.�ti�.._.__:Y�tG�-✓��.1�1'� �r,rrs,�t _.�;2Z� ��_-._ �,�iZ—�- -�--__-_.---- <br /> - <br /> _s�l��__._._�1��`� <br /> s ...lyyW �°#,dc:Y'- E✓ ._. -� 1� 4 -7F,,t �'��.� 4r�Y, ',� �� 1�. F 7 '�tFF,r K3- �, �'1�1 <br /> { ,t M 'F' i •T# 7 Iii <br /> ikll <br /> r <br /> el <br /> _A tty: <br /> u' c ! � to fire E �'� hone N�urr er 2- <br /> .1Correct: Incorrect: r (� <br />