Laserfiche WebLink
Waste Tire SL. Bey & Inspection Repm. Inspection Report Number <br /> CalRecycle State of California A 11 - 1177800 <br /> CalRecycle (Rev.Recovery <br /> Survey Fam _ page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) VV ��JJ <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection Type(Fill one) <br /> Site Suffix: 6 Q Ot '50 l © l 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: Sck�Y' 'SonuCt CIXI ✓V1_11 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> Ake(? ✓ 3 - i U <br /> Physical Address <br /> Inspection Date y <br /> l L Z- <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> * PM 0 0 ® PM <br /> Y�V� v1YYYi Ci <br /> 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 /> ® Active 0 Passenger 0 Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> CIPS Latitude • Hauler ® Indoor <br /> 0 0 Inactive ® Truck <br /> Longitude — 0 Planned 0 OTR 0 End-Use if Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 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 <br /> 0 Service Station ® Hauler 0 Agriculture 0 Shredder 0 Other ,� �eTr• le r <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS iZ <br /> Notice Of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 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 <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or E)CT) N <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 /> 2 <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators 0 In Compliance- No Violations o <br /> 0 0 Other:§ <br /> Comments ` <br /> Inspection Form Included: <br /> Comments Included: ® 6 2' <br /> usiness Re g re Phone umber 64pArctoKs Si ature Phone Number <br /> 62081 <br /> INSTRUCTIONS ON BACK I Correct:IS Incorrect: E X A L 11213] <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink C y: ® ■ <br />