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Observation Report Number <br /> HAULER OBSERVATION REPORT <br /> CalRec cle �"of�'f r"' IH-XXXXXXX <br /> Y c,»Ewyae XXX(Rev > <br /> DVL Of> R--ya.SId BLUE OR BLACK INK PEN <br /> ��r` 'flf~��'��11 > ���r�3�� �'�''"-l�u? ��.�.. �'s�•�o�e`II�a�one'�ai � � �1�: '��x�`s�`�-�i�;,,w '.:'- ._, <br /> O TPID-not available/not applicable <br /> 40 Observation during inspection at: r' <br /> TPID. 1 / 6 10 J� ''$ I� 0 Generator 0 End—Use Facility 0 Other. <br /> Vehicle II TPID-I V k-4 � I L Ie-L I3 I <br /> Plate State Q Observation in transit <br /> Decal r� _ + I I � I � Observation by l Inspector <br /> Number <br /> (Upplicablo) <br /> Observation Date ©' f <br /> Q Hauler Exempt: ' <br /> Hauler Name Observation Time <br /> AM <br /> Hauler <br /> /Address <br /> O aM <br /> Street l <br /> City state Zip Cade <br /> Driver's Name D.03. <br /> Location of Observation <br /> i-SIS t'��"•� ��.: .. .. _ . : . . <br /> Street <br /> 5 6Z For more information concerning Waste/Used Tire <br /> city state Zip code Hatiling&Manifesting,please call the Waste Tire <br /> r �oQgd h f Hotline at(866) 896-0600. <br /> Part B - <br /> a o51 <br /> O O PRC§42951-Waste Tire Hauler Registration and Transport ofTires O O PRC§42956(c)-Failure to Present Registration to official <br /> O O PRC§42952(b)-Falsely Represents self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42958(a)-Registration/Decal in Vehicle O O 14 CCR§18459-Hauler Complying vrith Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle ® O Other§ jLl cG t L I —`�o a- L Com, <br /> Comments/Driver's Statement: <br /> je <br /> - ! r_11 � ...._W.Lam.. lr�¢�._.__�n�%t._u1ir=✓s ;7Z° ioU :T-1n_r _ <br /> _-.:'�:�. <br /> v <br /> .._1.mp'i I�I?Y�_�/llrl c'� �i7 )._—✓1(�+- __...._... _� _ <br /> Nil <br /> FF:- ` -►•'31r <br /> p1 I ��}.t'}.• S � ��,L?' <br /> A,iAeOV <br /> 19a <br /> .5 f � � ti'.� � ;;i �''.' rte.i,:.:(�` .ar a � �...,.. .r_ ? LAY'• , !• .d. 1T.,. , .. <br /> Correct: Incorrect: iE+Zr <br />