Laserfiche WebLink
Oa Waste Tire Survey & Inspection Report Inspection Report Number <br /> CalRecycle State of cle181CaliforniaR 11 - 1177681 <br /> CalRecycle 181(Rev.y(Cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> `A-Survey BLUE OR BLACK INK PEN <br /> less Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> Site Suffix: ' ", ' 0 ® Routine Q Re-inspection Q Referral Q Observation <br /> LocalC - If Referral,choose referral type(Fill one) <br /> Identifier: `n -�uG�v��f\ CO�M� ( Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name ` Inspected By Inspector <br /> `'1 ;I 1 e V- rite n.fir>` l 3 - l © t ra vr2�y <br /> Physical Address L <br /> IAI,q�.i,��cw� ��l � <br /> `I Inspection Date <br /> T- ' n C(X'-'1q P cA C150,3 1 <br /> Time In Time Out <br /> Business Rep Title 2 O AM O AM <br /> 1-t� SG�L�G✓ U1CG �����- oZ : V 0 * PM � (� � ® PM <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 /> _&- Q Active 40 Passenger 4@1 Generator ® Outdoor <br /> O 0 Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR O End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Jew Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> V Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other one- —1 W--e— <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> Q Q Q Notice Of Violation Q Extension <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 8Q PRC§42956-Registration/Decal in Vehicle <br /> Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> LU <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities __ W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators I&In Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments ` <br /> tr,spection Form Included: O <br /> \ _ <br /> Comments Included: <br /> Business Rep's Siolature Phone Number ect is ignature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: NJ E X A E 1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink C py: ® ■ <br />