Laserfiche WebLink
Waste Tire S.. Bey & Inspection Repor. <br />CalRecycle State of California <br />CalRecycle 181 (Rev. (Cal Survey Form - Page 1 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Surve <br />Inspection Report Number ■ <br />I1 -1.176554 <br />BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />Inspection Type (Fill one) <br />TPID - <br />Site Suffix: 0 3 S 0 ( <br />® Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Local <br />Identifier: -y .� <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Business or Facility Nam <br />Inspected By Inspector <br />Keg nuvv% ► U -C --If l 1--O� cQ A G . <br />Physical Address <br />�f r P0�W <br />f� T I F PJ <br />/ <br />C;t GtCL <br />Inspection Date <br />Time In Time Out <br />Business Rep Title <br />n 0 AM _ 0 AM <br />a� <br />.2C) ® PM 0 PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)2 <br />3 <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />b <br />® Active <br />Q Passenger <br />® Generator <br />® Outdoor <br />O <br />GPS Latitude <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />Q Inactive <br />® Truck <br />O <br />Longitude - <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair ® Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture Q Shredder Q Other <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 />Q Notice Of Violation Q Extension <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Compliance Deadline <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Date M/M/m <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />(Required for NOV or EXT) <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q Referred / CalRecycle Enforcement <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />0 In Compliance - No Violations <br />Q <br />Q <br />Other: § <br />Comments J <br />,0 P 1201 knd <br />Inspection Form Included: Q <br />Comments Included: ® <br />- <br />Business Rep's Signature Phone Number nspector's Signature Phone Number <br />INSTRUCTIONS ON BACK Correct: 0 Incorrect: E X A M L 1 2 3 62081 <br />0 White Copy: CalRecycle Yellow Copy: Operator Pink Cop : © 0 <br />