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Survey & Inspection Report- S>>rvey Form (Page 1) Page 2 of 2 Part B - 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 ❑ 10 114 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements ❑ ❑ 14 CCR § 18459.1 -Tire Program ID Number and Certificate from CalRecycle ❑ ❑ 14 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 ONotice of Violation OExtension Compliance Deadline: (Required for NOV or EXT) OReferred / CalRecycle Enforcement *In Compliance - No Violations Comments: LA A Paragraph Font Family Font Sizes Routine waste tire inspection conducted on this date and the following was noted: No violations or areas of concern. Notes: v Signatures ❑Inspector's Signature❑ Business Rep's Signature Upload Inspection Survey PDF Browse... Created by: Harprit Mattu 7/26/2016 4:03 PM Last Updated by: Harprit Mattu 7/29/2016 8:41 AM Waste Tire Management System httos://secure.caIrecycle.ca.ciov/WTMS/ Contact: WasteTires(d)caIrecycle,ca.4ov 1-866-896-0600 (toll free) https://secure.calrecycle.ca.gov/WTMS/Inspection/Survey.aspx?SurveylD=236250&0rga... 7/29/2016