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MW <br /> HAULER OBSERVATION REPORT <br /> Ca1Rec cle State of Califomia <br /> Y CalRecycle 775(Naw 2/14) <br /> D,pt.1R< .­,R­dmg-dR«o y BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> O TPID-not available/not applicable <br /> Observation during inspection at: <br /> Generator O End—use Facility O Other: <br /> TPID- 1 8 2 1 2 6 9 — 0 1 <br /> Vehicle State <br /> TPID - 1 8 1 0 0 0 1 <br /> Plate Q Observation in transit <br /> Decal m _ Observation by Inspector <br /> Number <br /> (If Applica- <br /> O Hauler Exempt: Observation Date <br /> Q Hauler name&address not known <br /> Hauler Observation Time <br /> Izzy's World Of Tires 1 0 1 0 AM <br /> Hauler Address O PM <br /> 14090 <br /> Street ENFORCEMENT STATUS <br /> Alpine Rd <br /> City State Zip Code O Notice of Violation <br /> Lodi CA 95240 <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> Referred/Ca lRecycle, Tire Hauler Compliance Unit <br /> Street <br /> For more infonnation concerning Waste/Used Tire <br /> City State Zip Code Hauling & Manifesting, please call the Waste Tire <br /> Tire Load Count ❑ Hotline at(866) 896-0600. <br /> (used+waste) <br /> Part B - <br /> V A Hauler/Manifest Requirements V A Hauler/Manifest Requirements <br /> Q Q PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Official <br /> Q Q PRC§42952(b)-Falsely Represents Self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle O O 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle O O Other§ <br /> Comments/Driver's Statement: <br /> 1.) During the inspection at"Pacific Tire" with TPID#1810001-01 1 observed 3 manifests from Izzy's "World of Tire " <br /> that were not observed on WTMS. The manifests has past the 90 days and has not been reported to Cal-Recycle. <br /> The pickups were on 06/29/16, 06/07/2016, and 03/15/2016 with manifest numbers of 5582574, 5582571, and <br /> 5582560. <br /> Comment Form <br /> (209)468-2807 <br /> Photos <br /> Driver's Signature Phone Number Inspector's Signature Phone Number <br /> Correct : • Incorrect: X 40 <br />