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a <br />Waste Tire Survey & Inspection Report <br />CalRecycle State of California <br />CalRecycle 181 (Rev. (Cal Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Survey <br />e - cijr%t=%# <br />Inspection Report Number <br />I1 - 1242418 <br />BLUE OR BLACK INK PEN <br />Business Profile` <br />V <br />A <br />Inspection Details <br />0 <br />TPID - <br />Site Suffix: fGi <br />v <br />v <br />Inspection Type (Fill one) <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />J <br />0 <br />0 Routine 0 Re -inspection 0 Referral 0 Observation <br />If Referral, choose referral type (Fill one) <br />Local , <br />��-CL��� ��`� <br />Identifier:` <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />0 <br />0 CHP 0 CalRecycle 0 Complaint <br />0 Educational Visit 0 Other <br />Business or Facility Name <br />0 <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />By Inspector <br />0 <br />1Inspected <br />I +� l �VL���S <br />0 <br />0 <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Physical Address <br />0 <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />0 <br />m G 4�A <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />0 <br />0 <br />Other: § <br />Inspection Date <br />��+,,�Y• <br />La <br /><i <br />Time In <br />Time Out <br />Business Rep <br />Title1 <br />® AM <br />® AM <br />1 I .3 © Q PM <br />J <br />I ( � � 0 PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE) <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />' <br />.4(Fill <br />Active <br />0 Closed <br />0 Passenger <br />0 Altered <br />0 Generator <br />Q Hauler <br />® Outdoor <br />Q Indoor <br />O <br />GPS Latitude <br />0 Inactive <br />0 Truck <br />Longitude - <br />O <br />0 Planned <br />0 OTR <br />0 End -Use <br />0 Container <br />Business Type (Fill all that apply) <br />® New Tire Dealer 0 Auto Repair <br />0 Trucking Fleet <br />0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br />® Used Tire Dealer 0 Auto Body <br />0 Car Dealer <br />0 Collection 0 Crumb Rubber <br />0 Service Station 0 Hauler <br />0 Agriculture <br />0 Shredder 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 />0 <br />0 <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />0 <br />0 <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />0 <br />0 <br />PRC § 42956 - Registration/Decal in Vehicle <br />0 <br />0 <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />0 <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />0 <br />0 <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />0 <br />0 <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />0 <br />0 <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />0 <br />0 <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />0 <br />0 <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />0 <br />0 <br />Other: § <br />Comments <br />Inspection Form Included: <br />Comments Included: <br />INSTRUCTIONS ON BACK I Correct: <br />-C <br />Phone Number <br />Incorrect: ^1 v <br />White Copy: CalRecycle Yellow Copy: Operator Pink <br />ENFORCEMENT STATUS <br />0 Notice Of Violation 0 Extension <br />Compliance Deadline <br />Datem/m/m <br />(Required for NOV or EX7) <br />0 Referred / CalRecycle Enforcement <br />0 In Compliance - No Violations <br />Phone Number <br />62081 <br />r <br />v <br />0 <br />f <br />ww <br />i1= <br />