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.............. <br /> HAULER OBSERVATION REPORT <br /> CalRecycle SCfallReecyele 775 (New 2114) <br /> Dept.of Resources Rccyding and Recovery BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> Q TPID-not available/not applicable <br /> ® Observation during inspection at: <br /> Generator © End-Use Facility 0 Other: <br /> TPID- 3 1 � <br /> Vehicle State <br /> Plate 0 Observation in transit <br /> Decal m _ Observation by Inspector <br /> Number 7 �') - C: j 5ivtti Ix L)4L ki l4 (�1ti <br /> (If Applica- <br /> O Hauler Exempt: Observation Date ( C, / / <br /> O Hauler name&address not known L-LJ <br /> Hauler f Observation Time <br /> t r�I �- Corn rttA-;-aa 2.Tilt,��uj �: 6 0 AM <br /> Hauler Address ,, PM <br /> 1 COO S . 21 'f 5fr e" <br /> streetENFORCEMENT STATUS <br /> C)4+ *cc- <br /> city state Zip code O Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> CIO I lre P ® Referred/Ca lRecycle, Tire Hauler Compliance Unit <br /> Street , <br /> - For more information concerning Waste/Used Tire <br /> city State Zip Code Hauling& Manifesting, please call the Waste Tire <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> Q O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Official <br /> Q Q PRC§42952(b)-Falsely Represents Self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O 0 PRC§42956(a)-Registration/Decal in Vehicle (6 O 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle O O Other§ <br /> Comments/Driver's Statement: <br /> 9.c�L A-) c"�►Zdy���.� <br /> "-5W I TRID 13'Ito_}92-moi) Doyiy.T i-h.is ; c eTZ� <br /> dram i,u;n 1- L'arn►v,� r «Q. 7i�� � ,.,t s C Tn-1 <br /> wg t.Z 005erv._cam, CK--wk--. A 104.1, OE 35- C M 5 did, nO•f- eza2ka - <br /> t va of Lo V4 S So Ck_ �e►-ru��� � "5w iTt�".�`S.� a�tZ ± II L`�53 , <br /> J'�'- � l�stru2SS S )c u-►YI ri(wr��'s �i �0���L�t�T' eo�rKth�'rtic� 'T►r� <br /> `J bw�.S Cue + ,S Ly 1 :��• ���11%S CaF C j`L•�S Oj'ra ry a L at S Ea <br /> Comment Form 0 <br /> Photos ® Driver's Signature Phone Number Inspector's Signature Phone Number <br /> Correct: Incorrect: X �r <br />