Laserfiche WebLink
Waste Tire S6. fay & Inspection Report Inspection Report Number <br /> CalRecycle State of California �y <br /> Y CalRecycle181(Rev.10/10) C p p ��� ®M� _ ���A I1 1242380 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) � tU] A Page <br /> Part A-Surve BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspection31173 <br /> l ^ � , t o � Inspection Type(Fill one) <br /> Site Suffix: 1 / "� * Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocalIf Referral,choose referral type(Fill one) <br /> Identifier: S"�V_t Tom%�`v `G:511.3��.,/ 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name V <br /> Inspected By Inspector <br /> V N't%,C.P—Y\)` (-r e-V <br /> Physical Address v <br /> Z577 yds4zwl-\\-P-- a.oe_ <br /> ��337Time <br /> Date � 2 <br /> Time In Time Out <br /> Business Rep Title0 AM 0 AM <br /> '2 5 0 PM _Z ' 1 � A PM <br /> Y�' e �• Lah �� �Ga��� <br /> Operational Status Tire Type Business Role Storage Type <br /> 2 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> Tire Count (Whole/PTE) <br /> 40 Active 0 Passenger 40 Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GpS Latitude 0 Hauler 0 Indoor <br /> O 0 Inactive 0 Truck <br /> Longitude — 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 40 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other <br /> Part B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> LU <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators e In Compliance-No Violations o <br /> 0 1 0 1 Other:§ <br /> Comments b <br /> 0 <br /> Inspection Form Included: 0 <br /> Comments Included: ��� _ �?- e q�^32� <br /> � <br /> Busin ep's Signature Phone Number Insp toy's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: � � � IEIXIAIMIPILIEI 1112 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LFA ® 0 <br />