Laserfiche WebLink
Waste Tire SUS rey & Inspection Report inspection Report Number <br /> CalRecycle State of California I 1 - 1229904 <br /> CalRecycle 181(Rev. (Cal 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- 1 © - © 1 Inspection Type(Fill one) <br /> Site Suffix: a Routine Q Re-inspection Q Referral Q Observation <br /> Local ` If Referral,choose referral type(Fill one) <br /> Identifier: �G—h �O^�y V` Co V Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name "�'1 �, __�`77�� Inspected By Inspector <br /> Physical QAddress <br /> -70 <br /> �-`c`- Inspection Date o ` 1 ✓ 1 5 <br /> C�L0 V Time In Time Out✓ <br /> Business Rep Title O AM O AM <br /> A rt Z S PM ,s PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) " (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> -1 9 Active 10 Passenger Generator 40 Outdoor <br /> Q Closed Q Altered <br /> GPS Latitude � Hauler Q Indoor <br /> O Q Inactive 0 Truck <br /> Longitude - Q Planned Q OTR End-Use i Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station • 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§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> f <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators 40 In Compliance-No Violations o <br /> Q Q Other:§ ee\\ <br /> Comments <br /> oo K�b <br /> c 'a\ � � �C4_ wce (\ Coccc� <br /> IJ ; <br /> Inspection Form Included: Q <br /> Comments Include,13 <br /> Busi ess Rep's Signature Phone Number Inspect 's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: E X A M P L E 1 2 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA <br />