Laserfiche WebLink
■ Waste Tire Su, Bey & Inspection Report Inspection Report Number ■ <br /> CalRecycle State of California I 1 - 1196594 <br /> CalRecycle 187(Rev. (CalRecycle) Survey <br /> 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- � Inspection Type(Fill one) <br /> Site Suffix: `1 0 Routine O Re-inspection O Referral O Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: v OCHP OCalRecycle 0 Complaint OEducational Visit OOther <br /> Business or Facility Name <br /> Inspected By Inspector <br /> Physical Address ?j q - 1 C) <br /> �� � Inspection Date ' 2 � 1 9 � I 3 <br /> �C. 1 Time In Time Out <br /> Business Rep Title , O O 16AM C) C) *AM <br /> \ Q PM O PM <br /> gla- \o ,Z�G�CI'x_�� 2� <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) ci (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 0 Active 0 Passenger 0 Generator O Outdoor <br /> O Closed O Altered <br /> GPS Latitude O Hauler O Indoor <br /> O Inactive O Truck <br /> Longitude - O Planned O OTR O End-Use IS Container <br /> Business Type(Fill all that apply) <br /> O New Tire Dealer O Auto Repair O Trucking Fleet O Government O Retreader O Dismantler O Tire Derived Fuel <br /> O Used Tire Dealer O Auto Body O Car Dealer O Collection O Crumb Rubber <br /> O Service Station O Hauler O Agriculture O Shredder 40 Other Ma'\ SreCv\C.Q <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> O Notice Of Violation Q Extension <br /> O O PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> O O PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> O O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> O O 14 CCR§18459.1 -Tire Program ID Number from CalRecycle a <br /> O O 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EJC N <br /> v <br /> O O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> O O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers O Referred/CalRecycle Enforcement <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators In Compliance-No Violations o <br /> O O Other:§ - <br /> Comments O`n �Y�� (2>oN <br /> Inspection Form Included: O �^ <br /> Comments Included: ��z �3�L /1e^ <br /> Busin s Rep s Signature Phone Number Inspec or's Signature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK [Correct:0 Incorrect: E X A M P L E 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA © ■ <br />