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.............. <br /> HAULER OBSERVATION REPORT <br /> CalRecycle CalR cyc e 775(New 2/14) <br /> DepL of Reso—Recycling and Recovery BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> 0 TPID-not available/not applicable <br /> � Observation during inspection at: <br /> Q Generator 0 End—use Facility 0 Other: <br /> TPID- -3 — TPID-1 <br /> �j 10 9 <br /> Vehicle <br /> Plate State 0 Observation in transit <br /> Decal Observation by Inspector <br /> Number m — I MST Ty <br /> (If Applica- <br /> 0 Hauler Exempt: Observation Date <br /> 0 Hauler name&address not known ��LLII <br /> Hauler Observation Time <br /> 40 AM <br /> wtisdr. Wa.y T,r� Cbvr,.eo�,7,Thc.,(Y,e�c�� l 1 2 o <br /> Hauler Address 0 . <br /> 221 •W��So� VJ�-y <br /> Street ENFORCEMENT STATUS <br /> City State Zip Code o Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> Referred/CalRecycle, Tire Hauler Compliance Unit <br /> 917 19\0-0-c- �C�6v`- W&J 0 <br /> Street <br /> L.&-% CN C5Zy() For more information concerning Waste/Used Tire <br /> City State Zip Code Hauling& Manifesting,please call the Waste Tire <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> 0 o PRC§42951-Waste Tire Hauler Registration and Transport of Tires O o PRC§42956(c)-Failure to Present Registration to Official <br /> 0 o PRC§42952(b)-Falsely Represents Self as Registered Hauler O o 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 o PRC§42956(a)-Registration/Decal in Vehicle 0 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 o PRC§42956(b)-Hauler Using an Unregistered Vehicle o 0 Other§ <br /> Comments!Driver's Statement: <br /> c ----- <br /> LLC <br /> ----------- <br /> �_.�_��o <br /> — <br /> S-c3.�'C►�.�c 1��5,---�1�C..�__A�\�_33___-���=S—�.a�.ct.-2�c�c�c--�-���c. 9� <br /> eC <br /> n <br /> SQ�__C'�1,.__.S._etck• 06---_TeC _.L+ S._._L1..c.�� <�. ce�� S�� .__.__._-_ <br /> Comment Form 0 r <br /> a9-- bg�32 <br /> Photos Driver's Signature Phone Number Ins ector's Signature Phone Number <br /> Correct: Incorrect: X 4 <br />