Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number <br /> CalRec cle State of California <br /> Y CalRecycle 181(Rev.10/10) Survey Form - Page 1 11 - 1196495 <br /> r 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: J 1 ` 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: �,vx 0�Qd%>�� �vh�y Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name 1 ' Inspected By Inspector <br /> M,\kecc �h�,c���w.ean � 3 9 - 0 1 fi v <br /> Physical Address M � <br /> ZU(dVA Sk, <br /> Inspection Date 1 O / O 1 3 <br /> �,� e�0. C.A� �►533�, <br /> Time In Time Out <br /> Business Rep Title 1 0 AM 'z 3 0 AM <br /> 0 PM b 0 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 /> 1 ' Q Active Q Passenqer Q GeneratorA / 1 <br /> Q Outdoor <br /> 0 Closed Q Altered (A 1� <br /> GPS Latitude Q Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> 4iisiness Type(Fill all that apply) <br /> New 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 0 Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A I HAULING AND MANIFEST REQUIREMENTS <br /> Q Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m <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 EXE N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> uj <br /> w <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments�������sa� �1,C�Z�n-SP !✓'c\V� �Y� l�V� �=� [`,.]o,-'C� C�-AnC�, _ <br /> 4 2 (k <br /> Inspection Form Included: Q <br /> Comments Included: * `7 -Fpd•- <br /> Business Rep's Signature Phone Number Insp ctor's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: E X A M P L E 1112131 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />