Laserfiche WebLink
Waste Tire Sui vey & Inspection Report <br />CalRecycle State of California <br />CayclinglndRecvery(io) Survey Form - Page 1 <br />Dept of Resources Recycling and Recovery (CalRecycle) <br />'art A - Survey <br />Business Profile Inspection Details <br />TPID - <br />Site Suffix: 6 ?j 6 S-0 <br />Local <br />Identifier: � Guy-, 3C) \3kw,\ p <br />41— <br />Business or Facility Name <br />Physical Ad�1/ <br />�v�, �2S' u <br />ess <br />Zk1_t2 k -P. <br />C.k f <br />Business Rep Title <br />lel `cwx'Q�k St N&\ # <br />Tire Count (Whole/PTE) <br />GpS Latitude <br />Longitude <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair <br />Q Used Tire Dealer Q Auto Body <br />Q Service Station Q Hauler <br />U Trucking Fleet <br />Q Car Dealer <br />Q Agriculture <br />Inspection Report Number <br />11- 1229987 <br />BLUE OR BLACK INK PEN <br />Inspection Type (Fill one) <br />LA <br />C\ <br />s <br />Q Referral <br />Q Observation <br />If Referral, choose referral type (Fill one) <br />Q <br />0 <br />Q Educational Visit Q Other <br />Inspected By <br />0 <br />U Trucking Fleet <br />Q Car Dealer <br />Q Agriculture <br />Inspection Report Number <br />11- 1229987 <br />BLUE OR BLACK INK PEN <br />Inspection Type (Fill one) <br />V <br />A <br />0 Routine Q Re -inspection <br />Q Referral <br />Q Observation <br />If Referral, choose referral type (Fill one) <br />Q <br />Q CHP Q CalRecycle Q Complaint <br />Q Educational Visit Q Other <br />Inspected By <br />Q <br />Inspector <br />Q <br />3q -A <br />0���i'v <br />Q <br />Q <br />Inspection Date <br />Q 7�, <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Ti In <br />Q <br />Tim1e Ojut <br />Time <br />Q <br />qme <br />1 <br />AM <br />C <br />4D AM <br />lJ <br />✓ Q PM <br />1 <br />0 PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />• Active <br />Q Passenger <br />0 Generator <br />0 Outdoor <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />Q Inactive <br />0 Truck <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />V Government <br />Q Collection <br />Q Shredder <br />Q Retreader Dismantler Tire Derived Fuel <br />Q Crumb Rubber <br />0 Other I <V C�(_ ,p past" '�- W C,LSI <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />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 />010 <br />Other: § <br />Comments <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Datem/m/m e <br />(Required for NOV or EX7) I N <br />i <br />o <br />Q Referred / CalRecycle Enforcement <br />LU <br />W <br />In Compliance - No Violations o <br />Inspection Form Included: Q l i�`� ♦ <br />e � � <br />Comments Included: <br />Business Rep's Signature Phone Number Inspe tor's Signature Phone Number <br />INSTRUCTIONS ON BACK Correct:0 Incorrect: X*�]jEjXjAjMjPjLjEj 1112 3 62081 <br />■ White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA <br />