Laserfiche WebLink
Waste Tire S4. ✓ey & Inspection Report Inspection Report Number <br /> State of California <br /> CalRecycle 11 - 1210326 <br /> CalRecycle 181(Rev.10/10) <br /> (Cal Survey Fora - 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- 2 7 .5 'Ct , _ Q I Inspection Type(Fill one) <br /> Site Suffix: ` 7 "t ® Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: a� J V`� Ca0V Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> SVAe,eN Dc-o-'taJ 2 <br /> Physical Addres� 3 9 - O I M `f T v <br /> 1515 �Ocv Vloc'_C�' 2 ) <br /> L Ll 2-o Inspection Date <br /> S vo C-V�_o V, L-1 <br /> Time In Time Out <br /> Business Rep Title I C) 0 AM 1 O AM <br /> • PM ® PM- --- - Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ' 7 • Active Q Passenger ® Generator • Outdoor <br /> O Q Closed Q Altered <br /> Ia�S Latitude Q Hauler Q Indoor <br /> 0 Q Inactive 0 Truck <br /> Longitude - Q Planned Q OTR Q End-Use 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 B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V I A HAULING AND MANIFEST REQUIREMENTS <br /> Q 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 /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 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 EX7) <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 1 Q 1 Other:§ <br /> z <br /> Comments C <br /> A,o� <br /> Inspection Form Included: Q <br /> Comments Included: 0 — C <br /> Business Rep's Signature Phone Number Insrector's Signature Phone Number. <br /> __]jjjjjjj <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X EXAMPLE 1 213 62081 <br /> ® White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />