Laserfiche WebLink
Waste Tire Survey & Inspection Repos L Inspection Report Number <br /> CalRecycle State of California 11 - 1230149 <br /> CalRecycle 181(Rev. (cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ' I Inspection Type(Fill one) <br /> Site Suffix: * Routine Q Re-inspection Q Referral Q Observation <br /> Local1 If Referral,choose referral type(Fill one) <br /> Identifier: Sac_\' 0 !nt r`\ un Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> 1 Inspected By Inspector <br /> Co nnmLf� �p "(\ez.�n _ <br /> Physical Address l �S L OTTO <br /> Inspection Date s_/ o�/ O ^� / 1 S <br /> b kf�1 C(A <br /> Time In Time Out <br /> Business Rep Tit!a (, <br /> V U O PM I �1 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 /> Q Active Q Passsse/nger Q Generator Q Outdoor <br /> O * Closed Q AttePed� 1 " <br /> GPS Latitude Q Haul Q 11/0 <br /> 0 Q Inactive Q Truck <br /> Longitude — Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q Other I VJ A <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A 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 /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> w <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> Q O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators e In Compliance-No Violations o <br /> Q 1 Q 1 Other:§ 4(� <br /> Comments 1,1\3K4 e.'1\co. l f��JC� tt1.. <a ale bn7i)01S AOl'rJ <br /> l� A0A 7hnLV01 0A X)I O Pi, Wa-S <br /> 4-\ cA Nc) -J o)aki u'�S d S c�1e tLS CIF'(,>n()(�� n- <br /> Inspection Form Included: Q <br /> Comments Included: Q00. <br /> Business Rep's Signature Phone Number Insp is ignature Q Phone Number <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: E X A P E 1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy L ® ■ <br />