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HAULER OBSERVATION REPORT Observation Report Number <br /> s"S CleX"' <br /> CalRec cle 1 � KUM <br /> CaiRecyele oOe(Rev X=) 1H-X <br /> Dept.oResa°cs R-YW*z ed7"—y BLUE OR BLACK INK PEN <br /> r. H!'infix"IIJ � 'I �E'"'� ."> Y me�qq; �r I', 3 �: a Iyr�,.. t; ; <br /> 4Fa;'.L1• 1 J tvDserJvat[IOn6U 11a11� - 7kth <br /> 0 TPID-not available/not applicable <br /> Observation during inspection at: <br /> TPID- I I o 19 I q 19 I •I '� I— (� ( 4p Generator 0 End-Use Facility 0 Other. <br /> Vehicle I I I I I I I TPID-I t la I c I (0 l01 19 f_ o <br /> Plate State O Observation in transit <br /> Decal r� - I I I I IObservation by Inspector <br /> Number W 3 °I ' IiI 0 I . G s c 0 rro <br /> 0 Hauler Exempt <br /> Observation Date <br /> 5. <br /> Hauler Name Observation Time <br /> T06 T;re, Serv1 t,e , 5rjC. 0 AM <br /> Hauler Address , U O PM <br /> street E, of -I vp— 1.fI ikI l- Y,t i .I I i Ib <br /> City L Ock1 state 6A Zip Code <br /> 615-1140 <br /> Drive.es Name D.O.B. <br /> Location of Observation G <br /> street M V 101 —±a rc� �'s a rti"e r b f <br /> citystate z; code For more information concerning Waste/Used Tire <br /> K} Sd 1 Hauling&Manifesting,please call the Waste Tire <br /> Hotline at(866) 896-0600. <br /> Part B- <br /> 111 loll I <br /> RRC§42951-Waste Tire Hauler Registration and Transport of"fres 00 PRC§42956(6).Failure to Present Registration to Official <br /> 0 0 PRC§42952(b)-Falsely Represents Self.as Registered Hauler 00 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 PRC§42958(a)-Registration/Decal in Vehicle 0 0 14 CCR g 18459-Hauler Comptying with Manifesting Requirements <br /> 0 0 PRC§42958(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments/Driver's Statement: <br /> V1- <br /> -----'--------__.--��t��_. U'1�_��1 ._ i L1D o n...5 <br /> _ -- - -- <br /> 4:V�x� <br /> _To <br /> ve. <br /> . s <br /> • '� � l 1 1- 11 }} � • tl2 Yr�- <br /> m14-)el <br /> l <br /> 406 r 'vn - ._U.r�tS___i5�1/��l u�1rUr" IiagS-2 CL)4ta 45 WA�\ <br /> LA Qr\ ZA.1jj fn le <br /> �� 1� �"..�� , i ` `� , ,� is k� ;" � •� 1 �� : x <br /> tl�+Gp <br /> IW � t �"T�ern 1 tL y�^.�i y •��' D4� ,.�:` {` t'�'� � 9 <br /> y <br /> „l7ci ei phQ �q <br /> �` ���n ;;,� <br /> Correct: Incorrect: <br />