Laserfiche WebLink
Waste Tire Su. rey & Inspection Report Inspection Report Number <br /> State of California <br /> CalRecycle 11 - 1177824 <br /> CalRecycle 181(Rev.y(Cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ^ _ O Inspection Type(Fill one) <br /> Site Suffix: a( ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: SaLo '-J—Q I� — 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name <br /> p Inspected By Inspector <br /> 1 lee n br \ tw 3 <br /> Physical Address <br /> qaoi <br /> �� Inspection Date J- <br /> CA <br /> J Time In Time Out <br /> Business Rep Titl �1 O AM r� O AM <br /> �k4'f%6 � C-ln�tites � e {OWJ%,�ru�0.1?�' O ® PM v 0 PM <br /> m�i 1\f• Ik Operational Status Tire Type Business Role Storage Type <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 0Tire Count(Whole/PTE) <br /> ' 0 Active 0 Passenger 0 Generator 0 Outd000r <br /> GPS Latitude O 0 Closed 0 Altered O Hauler 0 Ind 119 <br /> O 0 Inactive 0 Truck <br /> Longitude - 0 Planned * OTR 0 End-Use 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 0 Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation 0 Extension <br /> 0 0 <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle N <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> 2 <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators A In Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments _fP T� I AWL Iitz-e L � -101 ) �-- <br /> No -yUa"sC0 <br /> Inspection Form Included: 0 �O � 93-.). 03ZI 4 <br /> , <br /> Comments Included: * �'7� <br /> � <br /> Business Rep's Signature Phone Number Insp tor's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: IEIXIAIMIPILIEI 1112 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA &A <br />