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Waste Tire SPI Vey & Inspection Repor , Inspection Report Number <br /> CalRecycle State of California 11 - 1255992 <br /> R <br /> CalRecycle 1 (Rev.y(Ca[ 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- Inspection�j, ' _ G Inspection Type(Fill one) <br /> Site Suffix: -( "[ , 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: V j TOOL9 Von C6Urj\ Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> D`)ir k.S-QL i) M-OrAtkky- TY c lw 1 ff <br /> Physical Address - t <br /> .2-S-49- U-3. �o5Q_rxax gym._ ., <br /> CA- '�,S 33_3- Inspection Date Q / ' 9 / <br /> Time In Time Out SCJ <br /> Business Rep Title Z 3 Co AM 0 AM <br /> lSi 3 � �4 PM <br /> 8ra�l,�. 11� .�nil`n, <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) :57 Q (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> _IActive Q Passenger * Generator 0 Outdoor <br /> Q Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> 0 Q Inactive 0 Truck <br /> Longitude - Q Planned Q OTR O End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Ip 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 <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§429; <br /> O O PRC§429; Compliance Deadline <br /> O O PRC§429G dGARDNIER TRUCKING, INC. <br /> Q Q 14 CCR§1 Date <br /> M / m / m <br /> O O 14 CCR§1 Bradley M. Lanting <br /> Q Q 14 CCR§1 2577 W.Yosemite Ave. (Required for NOV or EXn N <br /> Q Q 14 CCR§1 Manteca,CA 95337-9641 <br /> Q O 14 CCR§1 lers Q Referred/CalRecycle Enforcement <br /> Q MAILING ADDRESS <br /> O 14 CCR§1 u, <br /> Post Office Box 1450 Office—1-(209)249-3233 3 <br /> Q O 14 CCR§1 Manteca,CA 95336-1148 Mobile-111-(209)456-2929 ;nerators is <br /> In Compliance-No Violations <br /> Q Q Other:§ <br /> bradl@gardnertrucking.com o <br /> Comments Ky►�[Ili QD -' �.f 1 lilt //, a <br /> d <br /> d V, oY o c <br /> Inspection Form Included: Q //y, ZQ <br /> Comments Included: b <br /> Busine,A Rep's Signature Phone Number Inspector's Sig ure Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: X *� EXAMPLE 112 3 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />