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HAULER OBSERVATION REPORT Observation Report Number <br /> Caplet cle su3eorGtiromia III-XX� X <br /> 3 C&MccydeXX (Rev X=) <br /> DqL ertenwycli.z-e r BLUE OR BLACK INK PEN <br /> i f : IDyT {11J1 11"FI l'iR� i1F-. ! rf' `I�1 � 5.N <br /> I <br /> 0 TPID-not available/not applicable bill Sruz�i5. J i Y1�S <br /> ® Observation during inspection at: `( <br /> � 0 Generator 0 End-Use Facility 0 Other: <br /> TPID- lot I •T z--( -LL�LLJ <br /> VehicleTPID- L) 7 <br /> (� State <br /> Plate Q Observation in transit <br /> ! . . .. <br /> Decal <br /> Observation by Inspector <br /> Number EF I I I lu(I(Applicable) <br /> Observation Date <br /> 0 Hauler Exempt: ' <br /> Hauler Name Observation Time <br /> 0 AM <br /> Hauler Address <br /> Street L <br /> MIN", 0- offiffinnWayff MM <br /> 1�n11�v�1t� 0*6 Q-7.75t-( xr <br /> City State Zip Code <br /> y <br /> Y. <br /> Driver's dame D.O.B. <br /> Location of Observation <br /> zib .a. <br /> Street ' <br /> For more information concerning Waste/Used Tire <br /> city state Zip code .Hauling&Manifesting,please call the Waste Tire <br /> jfp L " e . �, Hotline at($56) $96-0600. <br /> /t `�����r,u► Iia t <br /> IS c �ide` $ iI;L�S'i.❑rl�:i. ;: i,.I s': <br /> Part B - <br /> I �. 01� 6'!� <br /> Q., lalwww <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tres 0 0 PRC§42956(c)-Failure to Present Registration to oificiat <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42958(a)-Registration/Decal in Vehicle 0 0 14 CCR§18459.Hauler Complying with Manifesting Requirements <br /> O 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle ® Cl Other§ -j 1 <br /> Comments I Driver's Statement: <br /> `-` <br /> r <br /> _, 1. Cl t - .• ,} G# 1�ie�p1 k�!"�J�E ,` j l A. � _ <br /> 101 '� SM <br /> . 1 - <br /> ✓ nY 331 <br /> c1tt- .�0�8-3'U' 'e <br /> a�., tl oDIe. is� u,ef �,i„rjtP ogreje 4 I'$ ', r, kl dee- tory ^lgn ce L r w <br /> *. s3s t. ?C irsL°Et �T�gGr: f ti, il i°� a: SnS' ?'.? L:_ <br /> Correct: 0 Incorrect: (0 <br />