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HAULER OBSERVATION REPORT Observation Report Number <br /> sWeofUi%nm x IH-LXX <br /> CalRecycle arR--Yaa xxx(R--) <br /> DqL ra, n--Ycfimg-dR--Y BLUE OR BLACK INK PEN <br /> �' r:,�i �t,vi'.�-ti;.C'tF 1 �1y i�..•' .a't '��ti `p�.y t' �1�'A, ''$�`+�r' 1"' .rx'.r � a ' �#r•� A'-� - <br /> f• F74A. •il (7J'.f :-•,74{ -E3il..'r!Si: l�.�n, r� {.)..�.'� S' Jf 4•.�k�X.. .:G.'rr. �i_ re lilt. <br /> 0 TPID-not available/not applicable <br /> Observation during inspection at: <br /> TPID- Q (7 9 _K5 » Generator 0 End—Use Facility 0 Other. <br /> IPID= 6 -3 _ a l <br /> Vehicle � State 17 <br /> Plate I � � � i O Observation in transit <br /> Decal Observation by Inspector <br /> T <br /> Number 3 9 — FFM i .1AA"t A- 1 w <br /> (if Applicable) <br /> Observation Date <br /> 0 Hauler Exempt: <br /> Hauler Name Observation Time <br /> Fisk T;�e �L�Rk�RE►��� o : v o A <br /> Hauler Address <br /> Street <br /> 55��yC. C9 5 ZoS o ;, <br /> City State Zip Code <br /> Driver's Name D.O.B. <br /> S � <br /> 1 <br /> Location of Observation <br /> Street <br /> 15-\or_V6Vl C Ac �152'1�7 For mor6 information concerning Waste/Used Tire <br /> city state Trp code Hauling&Manifesting,please call the Waste Tire <br /> r�jL�oad`Cu" ���J' ,}• t +�� t Hotline at(866) 896-0600. <br /> ,�Y pppt Cf.rd 1 1 _I.r l S Y 11 tYi <br /> • I ,�� 1rJ:.. 3 VY 3... <br /> Part B - <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tres 0 0 PRC§42956(c)-Failure to Present Registration to Official <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14CCR§.18456.4—Failure to Abide by Temporary Registration <br /> 0 0 PRC§42956(a)-Registration/Decal in Vehicle 0 0 14 CCR g 18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments I Driver's Statement: <br /> . . - =�•4_��sa�— �.�cyL�.�l�� ___ . <br /> yam, _ ----- - <br /> 74 <br /> 'e.._ <br /> '`°,i„F .'-,&S„ • W" � t� re s�•. r-t;t.•y � sit M <br /> W <br /> i -'i ,'G 1` t , �•/ 2^ <br /> a a):r <br /> 1"F � t.4edF+`� I�iRl• .� A'r'f�'vltt'J�"ty 7� *C !r ty,;yh, L r� al "+ 'RS}-�4' <br /> Driyerf r 49I�e ''s , t.` lti ct}os" In re� �� g,iho�7e�i]uref <br /> S-;'S. L!' ` .., ''� r't ?• lt�' `;�..1 a '�r,. M'k ,�'- 7 `..7 c'zs'fv ti��.a.`%i�..�r:F�`-�,.. �l:i'9PFi`.•'�`.�rv�'1.,. <br /> Correct: Incorrect: M a o <br />