Laserfiche WebLink
Waste Tire SaWy & Inspection Repoi Ispection Report Number <br /> CalRecycle State of California 11 - 1226557 <br /> CalRecycle 181(Rev. (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- I / Z - Q Inspection Type(Fill one) <br /> Site Suffix: 6 ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: J L'Vvl ry-- Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address (� 1 1 o I Irl <br /> Inspection Date <br /> 5 2-) S Time In Time Out <br /> Business Rep Title 0 AM Q AM <br /> ( . 3 C ® PM O c) O 0 PM <br /> OG11Y r <br /> �Cxl1/�LY Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) J (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ® Active ® Passenger ® Generator ® Outdoor <br /> Q Closed Q Altered <br /> � GPS Latitude Q Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use <br /> Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair ® Trucking Fleet Q Government Q Retreadery 0 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 B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility iENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> - - Fo <br /> Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§ 18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> Q Q 14 CCR§ 18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q Q 14 CCR§ 18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> Q Q 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> Q Q 1 Other:§ <br /> Comments <br /> + 1d�/vw 1 �e1 i i t i��✓ j_ _ _ ZG� I�iYL Cf1 �'c-- - <br /> 1 �, �rza L� c iZv�•! <br /> Inspection Form Included: Q Oil <br /> C"c.'e=/ 3 <br /> Comments Included: ®-- <br /> B mess Re s Si I a ur Phone Number spector's Signature Phone Number <br /> INSTRUCTIONS O Cor 0 Incorrect: E X A M P L 1 2 3 62081 <br /> ec <br /> y - <br /> White Copy:CalRecycle Yellow Copy:Operator Pink opy.L <br />