Laserfiche WebLink
Waste Tire Sule & Inspection Repo Anspection Report Number <br />CalRecycle State of California Y _ — <br />CalRecycle181 (Rev. 10/10) Survey Form Page 1 Il 1245028 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Survev BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />TPID -U- <br />Site Suffix: , -73 `2 <br />Inspection Type (Fill one) <br />1 <br />0 Routine 0 Re -inspection 0 Referral 0 Observation <br />If Referral, choose referral type (Fill one) <br />Visit 0 Other <br />Local <br />Identifier: <br />�13 <br />V <br />0 CHP 0 CalRecycle 0 Complaint 0 Educational <br />Business or Facility Name <br />Inspected By Inspector <br />� <br />Physical Addres <br />_ � o I /� v <br />� <br />q33 11�ac1�e.� <br />1 <br />Inspection Date c) -z z 1 S <br />Time In Time Out <br />Business Rep Title <br />1 1* AM 1 Q *AM <br />S ' <br />0 PM J 0 PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE) <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />0 Active <br />0 Closed <br />0 Passenger <br />0 Altered <br />0 Generator <br />A) (All <br />0 Outdoor <br />iv!A <br />O <br />GPS Latitude <br />Nr), <br />0 Haulier <br />0 Indoor <br />0 Inactive <br />0 Truck <br />O <br />Longitude - <br />0 Planned <br />0 OTR <br />0 End -Use <br />0 Container <br />Business Type (Fill all that apply) <br />0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br />0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br />0 Service Station 0 Hauler 0 Agriculture 0 Shredder * Other F42G' �,ey\ce <br />Part <br />B - <br />Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />ENFORCEMENT STATUS <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />0 Notice Of Violation 0 Extension <br />0 <br />0 <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />0 <br />0 <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Compliance Deadline <br />PRC § 42956 - Registration/Decal in Vehicle <br />0 <br />0 <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Date m / m / m <br />0 <br />0 <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />0 <br />0 <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />(Required for NOV or EX7) <br />0 <br />0 <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />0 <br />0 <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />I* Referred / CalRecycle Enforcement <br />0 <br />0 <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />U <br />iii iiun y iu-r�� - iviainicai.�yoicui iicywicnicnia ivi iuc ucnicio vi wvdbic iuc ucfcfdino <br />0 in Compliance - No Violations <br />IU <br />0 <br />0 <br />Other: § <br />Comment L. -A (}\ f-o%a AyN9-�y�CPQ_Atonc�v,64 ni, V�S X"re— oke l � <br />�ouow:r'c was <br />Inspection Form Included: 0 <br />P <br />Comments Included: • <br />Business Rep's Signature Phone Number Inspe or's Signature Phone Number <br />Y <br />INSTRUCTIONS ON BACK Correct: 0 Incorrect: <br />IEIXIAIMIPILIEI 11 2 3 <br />62081 <br />■ <br />White Copy: CalRecycle Yellow Copy: Operator <br />Pink Copy: LEA <br />© <br />0 <br />Y <br />