Laserfiche WebLink
Waste Tire *1ey & Inspection Repot' Inspection Report Number <br />CalRecycle State of California -1196423 ■ <br />CalRecycle <br />nd R cover (Cal Survey Form - Page 1 I1 119 6 4 2 3 <br />Dept. of Resources Recycling and Recovery (CalRecyclel <br />'art A - Survey r� � i BLUE OR BLACK INK PEN <br />Business Profilej�` Inspection Details <br />TPID - Inspection Type (Fill one) <br />Site Suffix: l. 5 J a Ll S - 0 0 Routine 0 Re -inspection 0 Referral 0 Observation <br />Localc ` If Referral, choose referral type (Fill one) <br />Identifier: sc"VL 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br />Business or Facility Name v <br />Physical Address <br />Business Rep <br />Tire Count (Whole/PTE) <br />GPS Latitude <br />Longitude - <br />Business Type (Fill all that apply) <br />(9 New Tire Dealer 0 Auto Repair <br />0 Used Tire Dealer 0 Auto Body <br />0 Service Station 0 Hauler <br />Title <br />e s <br />U Trucking Fleet <br />0 Car Dealer <br />0 Agriculture <br />Inspected By <br />3 1� - 1 p <br />Inspector <br />A-P�AngVA_ A <br />Inspection Date /0 <br />/ -)--3 13 <br />Time In Time Out <br />Government <br />0 Collection <br />0 Shredder <br />Retreader <br />0 Crumb Rubber <br />0 Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />. ®AM <br />A <br />1 S J QPM <br />Business Role <br />Operational Status <br />Tire Type <br />PRC § 42 <br />PRC §429 <br />(9 Generator <br />(Fill one only) <br />0 Active <br />0 Closed <br />(Fill all that appy <br />0 Pasen er <br />0 Altered <br />O <br />O <br />0 Inactive <br />0 Truck <br />14 CCR § <br />0 Planned <br />0 OTR <br />Government <br />0 Collection <br />0 Shredder <br />Retreader <br />0 Crumb Rubber <br />0 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 />Business Role <br />0 <br />0 <br />0 <br />0 <br />PRC § 42 <br />PRC §429 <br />(9 Generator <br />0 <br />0 <br />PRC § 42d ; egi. <br />0 Hauler <br />0 <br />0 <br />14 CCR § <br />0 <br />0 <br />14 CCR§ <br />0 <br />0 <br />14 CCR §- <br />0 <br />0 <br />14 CCR§ <br />i <br />0 <br />0 <br />14 CCR § <br />ulers <br />0 <br />0 <br />14 CCR§ { <br />u— <br />s <br />641 V CHAIM WAY <br />0 <br />0 <br />14 CCR § <br />01001XTpfi, CA 15200 generators <br />n <br />n <br />r: <br />Othe§ <br />riffle€- 200.462,5001 <br />0 End -Use 10 Container <br />Dismantler U Tire Derived Fuel <br />ENFORCEMENT STATUS <br />0 Notice Of Violation 0 Extension <br />Compliance Deadline <br />Date m/m/m <br />(Required for NOV or EXT) <br />0 Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />Comments�t --f <br />�r�c l��t: nsf1��-fi.� s�a�IvrP�� iii►+ 1 c s� �Uo v 7rwt�) Ii�6k J < <'t �J <br />T-tvc> A GAP L& Zmae Ciw-my)# lb" 2-Ix's , Lrr coat Otav, 0 -CS <br />Inspection Form Included: <br />Comments Included: <br />o 4-70, <br />Phone Number <br />INSTRUCTIONS ON BACK I Correct: I* Incorrect: Kip V <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink <br />Eli <br />Phone Number <br />62081 <br />® ■ <br />0 <br />N <br />0 <br />LU <br />LU <br />O AM <br />Z <br />0 ® PM <br />Business Role <br />Storage Type <br />(Fill all that apply) <br />(Fill all that apply) <br />(9 Generator <br />0 Outdoor <br />A04 <br />0 Hauler <br />0 Indoor <br />0 End -Use 10 Container <br />Dismantler U Tire Derived Fuel <br />ENFORCEMENT STATUS <br />0 Notice Of Violation 0 Extension <br />Compliance Deadline <br />Date m/m/m <br />(Required for NOV or EXT) <br />0 Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />Comments�t --f <br />�r�c l��t: nsf1��-fi.� s�a�IvrP�� iii►+ 1 c s� �Uo v 7rwt�) Ii�6k J < <'t �J <br />T-tvc> A GAP L& Zmae Ciw-my)# lb" 2-Ix's , Lrr coat Otav, 0 -CS <br />Inspection Form Included: <br />Comments Included: <br />o 4-70, <br />Phone Number <br />INSTRUCTIONS ON BACK I Correct: I* Incorrect: Kip V <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink <br />Eli <br />Phone Number <br />62081 <br />® ■ <br />0 <br />N <br />0 <br />LU <br />LU <br />