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Survey & Inspection Report 0[rvey Form (Page 1) Page 2 of 3 _W_._ ___ _. .__ ._.. _ - ._- ._ .�.'io. - - _ , - Part B - Inspection of Waste Tire Dealer, Generator,and End-Use Facility Part B - Inspection of Waste Tire Dealer, Generator, Hauler, and End-Use Facility V A HAULING AND MANIFEST REQUIREMENTS ❑ ❑ PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires ❑ ❑ PRC § 42953 - Contracts with Registered Waste Tire Haulers ❑ ❑ PRC § 42956 - Hauler Registration/Decal in Vehicle ❑ ❑ 14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements ❑ ❑ 14 CCR § 18459.1 - Tire Program ID Number and Certificate from CalRecycle ❑ ❑ 14 CCR § 18459.2.1 - Submittal of Manifest Forms and Tire Trip Logs within 90 days ❑ ❑ 114 CCR § 18459.3 - Retention of Manifest Forms and Tire Trip Logs for 3 years ❑ ❑ 14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers ❑ ❑ 14 CCR § 18461 - Manifest System Requirements for Waste Tire End-Use Facilities ❑ l❑ 14 CCR § 18462 - Manifest System Requirements for Waste Tire Generators ❑ ❑ Other 14 CCR § ENFORCEMENT STATUS Notice of Violation ❑Extension Compliance Deadline: (Required for NOV or EXT) OReferred / CalRecycle Enforcement C10)�In Compliance - No Violations Comments: Lam , o I z - oo A A Ll Paragraph .. Font Family - Font Sizes Routine waste tire inspection done on this date and the following was noted: No violations or areas of concern G Notes: 1. Permission to conduct inspection given by Jose Anguiano, Owner. 2. Inspection was done with Jose Anguiano. 3. A direct count was used in counting the tires. v Signatures Inspector's Signature 0 Business Rep's Signature Upload Inspection Survey PDF Browse... Administrative Notes Message for CalRecycle: https://secure.calrecycle.ca.gov/WTMS/Inspection/Survey.aspx?SurveyID=243793&0rg... 12/27/2016