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HAI,. A OBSERVATION REPORT <br /> of Cama <br /> CalRecycle CalRecy,le'fo775(tdcw2/14) <br /> C4LurRc.—.Rey.Ugsud R=­y BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> O TPID-not available/not applicable <br /> 0 Observation during inspection at: <br /> TPID- <br /> _� O Generator O End-Use Facility O Other: <br /> ! � �„ '- <br /> VehicleTPID- —) � Y _ <br /> Plate State O Observation in transit <br /> Decal Observation by Inspe{c�tor <br /> Number <br /> (If Applira- m l Al"'1AM0 Li--A <br /> O Hauler Exempt: Observation Date <br /> O Hauler name&address not known <br /> Observation Time <br /> Hauler <br /> "77—iv-C3, Z-1 L.if 0 AM <br /> Hauler Address m 0 PM <br /> Street ENFORCEMENT STATUS <br /> r'lc,a. LA q5 <br /> city state Zip Code O Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> A] - C1 ih �� - Referred/Ca I Recycle, Tire Hauler Compliance Unit <br /> Street <br /> f1(;(,1A I-Zee,_ CA C 5533 k, For more information 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 /> O O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O Q PRC§42956(c)-Failure to Present Registration to Official <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler Q O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle 0 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 /> _ c� ,re.�.�����_�c�.�..1 c�:�,_ c�v��1,Y►._��--}c.._c�._ e� � ��cam._C t l�i�,�� <br /> _C u, _rens� +, -=�,� - _! -.Le ► ,-, __. vtc�,�__..11i Of C n_ I_a Crr <br /> �iP� _1_ _� 3 <br /> Vl. <br /> _ TIc-cT..V1tz <br /> ----_ cls�--.�__�_cc.�v��.---�I�v�__ .E��,,c�.�-_..__>'tc�_-..�-r'-:t�S__�....._��r✓.__._�_t�1',��---ice_,---- <br /> .h.r <br /> L �s. z� -- r1v�- -t-vc�� _ +rr-�-_ _► 1xtiv�ct nzc';2 _._sy��J+c- pcz—K��l <br /> Comment Form <br /> Photos O Driver's Signature Phone Number ! e��f's gnature Phone Number <br /> Correct: Incorrect: <br />