Laserfiche WebLink
Oa Waste Tire Survey & Inspection Report <br />State of California <br />CalRecycle 10/10) <br />CalRecycle <br />ndR (Rev. Recovery <br />Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Sllfrvav <br />Inspection Report Number ■ <br />I1 -1226213 <br />BLUE OR BLACK INK PEN <br />Business Profile <br />V <br />Inspection Details <br />HAULING AND MANIFEST REQUIREMENTS <br />TPID - q <br />Site Suffix: ``, Q 53 <br />0 <br />Inspection Type (Fill one) <br />Q <br />6 ( <br />( <br />& Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Local C <br />Identifier: �CtrL C r��ti� <br />Business or Facility Name <br />Q <br />Inspected By Inspector <br />;.' <br />�C lrl. JC�d�h v cck/ t/'f 0 tCT! <br />104> C, 1 <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Physical Addresid <br />Q <br />1 0 l <br />4-rz%m <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />O <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Inspection Date I / <br />'? I / <br />Q <br />O <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Q <br />Other: § <br />Time In <br />Time Out <br />Business Rep Ti+tlle_ <br />(? , 5 ® AM <br />® AM <br />% <br />+ ` <br />vV1 <br />' <br />G-emc,_ • _ <br />O PM <br />QPM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)(Fill <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />® Active <br />® Passenger <br />® Generator <br />® Outdoor <br />GPS Latitude <br />O <br />Q Closed <br />Q Altered <br />Q Hauler <br />®Indoor <br />Q Inactive <br />Q Truck <br />Longitude - <br />O <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair Q Trucking Fleet 0 Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />O <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />O <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />O <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Q <br />Other: § <br />Comments <br />Inspection Form Included. U <br />Comments Included: a ��'� 3%� <br />Business Rip's Signature Phone Number I p or', <br />INSTRUCTIONS ON BACK Correct: Incorrect: XA � V E X A M <br />White Copy: CalRecycle Yellow Copy: Operator Pink Copy: <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />10 In Compliance - No Violations <br />Phone <br />62081 <br />SEA <br />■ <br />