Laserfiche WebLink
Waste Tire Survey & Inspection Report inspection Report Number ■ <br /> CalRecycle State of California 1210594 <br /> CalRecycle R(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- Inspection Type(Fill one) <br /> Site Suffix: (9 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocalC j� � >� If Referral,choose referral type(Fill one) <br /> Identifier: Ju `��' "�,i'`/ 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> Physical Address L I'\/T �j <br /> Inspection Date - / ( ' <br /> Time In Time Out <br /> Business Rep Title Q AM O AM <br /> ,/► I `. � Lt( � QPM r 1 C70 PM <br /> �GIvL I IC7�f �LS ��'r�vYh IZk <br /> - - --- Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) (Fill one only) (FII all that apply) (Fill all that apply) (Fill all that apply) <br /> �/J <br /> ® Active ® Passenger 0 Generator (a Outdoor <br /> 0 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler Q Indoor <br /> 0 0 Inactive (V Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair ®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 IrVICf_D - / <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder �! Other ��" c,j9>A,Aglt��v.4.4, 1 SI S <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 0 Q Notice Of Violation 0 Extension <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 /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle a <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 <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> Lu <br /> W <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities _ <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance-No Violations o <br /> O Q Other:§ <br /> - z <br /> Comments <br /> Inspection Form Included: 0 <br /> Comments Included: 0 ` <br /> Bu s Rep's Signature Phone Number a or n ure Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: E X AIM 1 2 3 62081 <br /> ® White Copy:CalRecycle Yellow Copy:Operator Pink Co y: ® ■ <br />