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Survey & Inspection Report 1Wey Form (Page 1) ' Page 1 of 3 <br /> Waste Tire Management <br /> System 3.86.0054 Authorized Use Only Home I Reports I Help I Sign Out <br /> Hide Survey Form (Page 1):JORGEN A JORGENSEN (TPID:1072171) <br /> Report is in SUBMITTED status - CalRecycle approval of this inspection report is <br /> pending. <br /> Survey Submitted for CalRecycle review. <br /> Part A - Survey <br /> Create PDF from M Email Inspection To Facility Operator M Inspection Form Number: IW- <br /> this Inspection Emailed on 10/10/2016 1045656 <br /> electronic survey (open Documents tab) <br /> * TPID - Site Suffix: 1072171 - 01 <br /> Found in Database <br /> JORGEN A JORGENSEN <br /> 2955 N Wilson Way <br /> Stockton, CA 95205-2644 <br /> Local Identifier: San Joaquin County <br /> Business Rep: Pat Laird Title: Manager <br /> * 0 Tire Count: 82 <br /> Latitude: Longitude: o <br /> * Inspection Type:R Routine,_, Re-inspection[_J Referral F-1Observation <br /> If referral, referral type:1-1 CHP El CalRecycle Fl Complaint f.._I Educational Visit Other <br /> Inspected By: 39-101 San Joaquin County _V <br /> * Inspector: Harprit Mattu <br /> * Inspection Date: 10/5/2016 v <br /> * Time In j 1:30 PM <br /> 1:45 PM <br /> * Operation Status Tire Type Business Role Storage Type <br /> Active <br /> Passenger Generator ❑Outdoor <br /> Closed Altered ❑ Hauler ❑ Indoor <br /> Inactive <br /> Planned Truck ❑ End-Use ❑ Container <br /> OTR <br /> Business Type: <br /> New Tire Dealer Auto BodyAgriculture r Retreader <br /> Used Tire Dealer❑ Hauler ❑Government C Crumb Rubber <br /> Service Station ❑Trucking Fleet❑Collection Dismantler <br /> Auto Repair ❑ Car Dealer ❑Shredder ❑Tire Derived Fuel <br /> Other Business Type Other: Motorcycle Sales/Service <br /> https://secure.calrecycle.ca.gov/WTMS/Inspection/Survey.aspx?SurveylD=240864&0rg... 10/10/2016 <br />