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Survey & Inspection Report Orvey Form (Page 1) • Page 2 of 3 Parti- Inspection of Waste Tire Dealer, Generator,and End-Use Facility Part B - Inspection of Waste Tire Dealer, Generator, Hauler, and End-Use Facility V A HAULING AND MANIFEST REQUIREMENTS ❑ ❑ PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires ❑ ❑ PRC § 42953 - Contracts with Registered Waste Tire Haulers ❑ ❑ PRC § 42956 - Hauler Registration/Decal in Vehicle ❑ ❑ 14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements ❑ JEJ 114 CCR § 18459.1 - Tire Program ID Number and Certificate from CalRecycle ❑ ❑ 114 CCR § 18459.2.1 - Submittal of Manifest Forms and Tire Trip Logs within 90 days ❑ ❑ 14 CCR § 18459.3 - Retention of Manifest Forms and Tire Trip Logs for 3 years ❑ ❑ 14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers ❑ ❑ 14 CCR § 18461 - Manifest System Requirements for Waste Tire End-Use Facilities ❑ ❑ 14 CCR § 18462 - Manifest System Requirements for Waste Tire Generators ❑ ❑ Other 14 CCR § ENFORCEMENT STATUS Notice of Violation t JExtension Compliance Deadline: (Required for NOV or EXT) UReferred / CalRecycle Enforcement 0In Compliance - No Violations Comments: R� . 4i t� B I !-jS X� _X l� _ _ ;(te=a =� ►_ �� ? ® •- . Paragraph Font Family - Font Sizes a �� Routine wastel tire inspection done on this date and the following was noted: Aj No violations or areas of concern I Notes: 1. Permission to conduct inspection given by Sam Sweeten, Owner. 2. Inspection was done with Sam Sweeten. 3. A direct count was used in counting the tires. v Signatures 11 Inspector's Signature❑ Business Rep's Signature Upload Inspection Survey PDF e Browse... Administrative Notes Message for CalRecycle: https:Hsecure.calrecycle.ca.gov/WTMS/Inspection/Survey.aspx?SurveyID=243 790&0rg... 12/27/2016