Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number <br /> CalRecycle State of California I 1 - 1230128 <br /> CalRecycle 181(Rev.y(Cai Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- _ O Inspection Type(Fill one) <br /> Site Suffix: ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local C4! ^V O1 Wv 1/ If Referral,choose referral type(Fill one) <br /> Identifier: <br /> 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> as1 <br /> SLel <br /> Physical Address <br /> n aS-Zti Inspection Date <br /> (�rl�eCr," /A Time In Time Out <br /> Business Rep Title �� O AM o/1 O AM <br /> oC O U ® PM c�- V PM <br /> J ess;cti M�u�el1 UW�,�r . <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 0 Active 0 Pass 0 Generator 0 yO�u/01rq <br /> tdoor <br /> O Closed Altere 'r ' ) ►`GPSLatitude 0 4� 0 Hauler', 0 In <br /> � 0 Inactive 0 Truck <br /> Longitude — 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 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 /> 0 0 PR - 0 Notice Of Violation 0 Extension <br /> C§42951 Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years `0 <br /> 0 <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> In Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments w'J �l J" In i►7Y� UW (�'1 t"P% Ct ' " A< 1J � i`r7 <br /> w(At) -nr0 - D 'olw ups r contcin, <br /> Inspection Form Included: 0 1/�r,_� <br /> Comments Included: 0 J 1 �j <br /> Business Rep's Signature Phone Number Ins tor's Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: E X A L E 1 2131 <br /> 0 White Copy:CalRecycle Yellow Copy:Operator Pink Cop :LE © ■ <br />