Laserfiche WebLink
Oa Waste Tire Sfiey & Inspection Report Inspection Report Number <br />State of California <br />CalRecycle I l- 1230204 <br />CalRecycle (Rev. Recovery <br />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 - Q © � Inspection Type (Fill one) <br />Site Suffix: > ` ! Routine Q Re -inspection Q Referral Q Observation <br />Local ` If Referral, choose referral type (Fill one) <br />Identifier: S�V1 'No Co v�-}v Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Business or Facility Name I �t 11 Inspected By Inspector <br />_ � <br />Physical Address 5 9 <br />\01bS S. Mc 1��hry Av-e. <br />� <br />e- 2 Inspection Date f 1 / I S C0.�r �� 32o Time In I Time Out <br />Business Rep Title i ) I 0 *0 PM AM r ` C)-0&PM � AM <br />��. 1 � 1 <br />Operational Status Tire Type Business Role Storage Type <br />Tire Count (Whole/PTE)ry (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br />` 0 Active Q Passenger 0 Generator 9 Outdoor <br />O Q Closed Q Altered <br />GPS Latitude Q Hauler Q Indoor <br />O Q Inactive Q Truck <br />Longitude — Q Planned 0 OTR Q End -Use Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair Q 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 * Otherariv�� <br />t <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />I HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Q <br />Other: § <br />Comments T7 _ \ , _ _ \ _ �L -, -- n .. _ t ` 1 <br />U55 yv�� A `- <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />•In Compliance - No Violations <br />Inspection Form Included: U�U/& <br />1656i'L&2 <br />Comments Included: <br />Business Rep's Signature Phone Number Insp ctor's Signature Phone Number <br />INSTRUCTIONS ON BACK I Correct:* Incorrect: jEjXjA�MjPjLjEj 1112 3 62081 <br />White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA <br />R <br />fV <br />0 <br />f <br />LU <br />LU <br />