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1 <br /> HAULER OBSERVATION REPORT <br /> CalRecycle fomia <br /> CalRecycle'775(New 2/14) <br /> Dcpl.of Resowca Recycling mid Recovay BLUE OR BLACK INK P E N <br /> Hauler Profile Observation Details <br /> 0 TPID-not available/not applicable ® Observation during inspection at: 11`t v e&T(ye S <br /> 9 Generator O End—Use Facility p Other: <br /> TPID- ? r'j F_7 <br /> TPID - cZ. �� (� 7 — b <br /> Vehicle State <br /> Plate 0 Observation in transit <br /> Decal Observation by Inspector <br /> Number m 1 C7 l i A )�-1 lq-mtl , ULA <br /> (If Applica- <br /> 0 Hauler Exempt: Observation Date <br /> 0 Hauler name&address not known <br /> Observation Time <br /> Hauler ® AAMf � <br /> W4L�l p 1�J1 lee �� — <br /> Hauler Address ! 1 L Q PM <br /> Street ENFORCEMENT STATUS <br /> q__7 -7--L( <br /> City State Zip Code 0 Notice of Violation <br /> Compliance Deadline <br /> Driver's Name D.O.B. <br /> Location of Observation <br /> _Izib CAV,,,y}t'� �A �I Referred/CalRecycle, Tire Hauler Compliance Unit <br /> Street l <br /> -StT<- 61 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 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires 0 0 PRC§42956(c)-Failure to Present Registration to Official <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 /> 0 0 PRC§42956(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 ® 0 Other§_TlLt (_'C t6L1 SG e <br /> Comments I Driver's Statement: <br /> r'r � - �,._._-:771,4V­ <br /> ���v-�v-c____C:.,.�:_��-- �1..�-�.��1�,b_..�.._-.�e��m_�c�._.•l�z�.__..� �1� __ �c��i� � U��_c�___...—__.. <br /> _ '`�'�� �-iY�.-Y�_._ ► .1 �ltt._Q -�- d'�'w_ �- ?�_c> .Ll -matin 1.. � �_ _ i2`rvt <br /> m1:ec hxyi <br /> 5...._.VHG��I►_ .1 _ .Cc� <br /> - Ap�l_-`ti- _a-o t-t-I_,..._�hG t-r��_ _ u_�-_ c�•t,\_�-1�,_-y►ncti.�.1�_ �t� _ _���et�.--_. <br /> •' tet' _ .__ . <br /> Comment Form <br /> Photos Driver's Signature Phone Number I ec r' Signature Phone Number <br /> rr +• T " $`1_ (-/-) <br />