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} } <br />.6 kste Tire Survey & Inspection Report Inspection Report Number ■ <br />,I Survey Form - P 1 I1 - 1177664 <br />TM- � 6 � <br />Surffiir:' <br />PIRG§ 42951 - Wastp.Tire Hauler Registration and Transport of Tires <br />lf*X atlbri Type mail one) <br />Routine 0 Re-inspacticn o Referral o Observation <br />�ot�l <br />� <br />0 <br />If <br />Ref yail' choose referral Type r* onejCHIP � �o CalRacycle o ConSpladnt o Educational rrsa o other <br />&Wnew..or Fealty Name <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Inspected By f or <br />i� __"• <br />by lxrNSi�JiCT� bM1 <br />14 CCR § 18459.2.1- Submittal of Comprehensive Trip Logs within 90 days <br />} 0 <br />ii <br />i7!1b.Ul, <br />14 CCR § 18480.2 - Manifest System Requirements for Registered Waste T]re Haulers <br />0 <br />14 CCR § 18W - Manifest System Requirements for Waste Are End -Use Facilities <br />.L�` <br />A <br />Inspection Date ` /!0 <br />1 01tw- <br />comftwilift <br />Tlme In Time Out <br />Rep <br />Tltls <br />AM ' AIN <br />T nk N <br />`• a to o� � , • b owl <br />n <br />OP&O4 <br />(Fill tine vol y <br />{# a%j <br />Rte. <br />(Fpr"al[ that apply] <br />..appm <br />s <br />RctiVe <br />". <br />Generator <br />CiPSr Leda <br />0 Closed <br />0Inactive <br />r <br />0 Hauler <br />0 <br />Longftmft0 <br />Planrted <br />0 End -Use <br />New Tire Fier` Auto, Repair <br />0 T=king Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br />0 Used Tire Deafer 0 Auto Body <br />0 Car Dealer 0 Collection 0 Crumb Rubber <br />0 SaiviceStation 0 Hauler <br />0 Agriculture 0 Shredder 0 Other C6e° "-T—mc- Cktxn ' 1J <br />Part B - Inspoction of Wash Time Dealer, Owerator, Harder and End -Use Facility <br />0 <br />PIRG§ 42951 - Wastp.Tire Hauler Registration and Transport of Tires <br />0 <br />PRC .§ 42953 - Contracts with Registered Wasts Tire Haulers. <br />0 <br />PRC § 42959 - RegistratiorYDecal in Vehicle <br />): 0' <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />0 <br />14 CCR § 18459.1 - -tire Program ID Number from CalRecycle. <br />0 <br />14 CCR § 18459.2.1- Submittal of Comprehensive Trip Logs within 90 days <br />} 0 <br />14 CCR-§ 184:59:3 - Retention of Comprehensive;Tiip I.ogs.for 3 years <br />0 <br />14 CCR § 18480.2 - Manifest System Requirements for Registered Waste T]re Haulers <br />0 <br />14 CCR § 18W - Manifest System Requirements for Waste Are End -Use Facilities <br />0 <br />14 OCR § 18462:- ManifestSystem Requirements for Tire [Dealers or Wasts'nre Generators <br />i 0 <br />1 01tw- <br />comftwilift <br />•i� Cla sof vlolatlon 0 <br />GohVliarkm Deadline <br />Date M1,3�� <br />lfregl" for ]IdOV rar`�1 <br />0RAWWI! QdR <br />0 bw Compillafte No V <br />Catrasp�>.# <br />INSTRUCTIONS 4N BACK Op�*. Inconvet X A !. 1 2 3 62081 <br />■ Write Copy: Cainecycle Yellow Copy: Operator Pink Copy: LEA ® ■ <br />