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Waste Tire SIy Ney & Inspectoon HapOO f.0 Inspection Report Number <br />CalRecycle State of California — <br />Y CalRecycle 181 (Rev. 10/10) Survey Form - Pa I 1 1242254 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Survey - BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID - / Inspection Type (Fill -one) <br />Site Suffix: ' Q CA S 6 ( ® Routine Q Re -inspection Q Referral Q Observation <br />Local C _ <br />Identifier: <br />Business or Facility Name <br />Lus Lois S�v� <br />Physical Address v <br />'2.40 n1.. � e � �� e� t_ ►� <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Inspected By Inspector <br />3 '�:'t- t O 1 -A K A -m 6 0--A <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V T A I HAULING AND MANIFEST REQUIREMENTS <br />Q <br />6A <br />asa�o <br />Inspection Date <br />I / <br />� —? / <br />C <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Time In <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Time Out <br />Q <br />Business Rep <br />Title <br />Q <br />l q_ : 9 <br />O AM <br />O ®PM <br />I � <br />O AM <br />d 0 PM <br />�e�rre�-}- C61�✓n. <br />� <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole <br />g � <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />� <br />� <br />to Active <br />® Passenger <br />0 Generator <br />Q Outdoor <br />��� Latitude <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />Q Inactive <br />* Truck <br />Longitude - <br />O <br />Q Planned <br />Q OTR <br />Q End -Use <br />Container <br />Business Type (Fill all that apply) <br />® New Tire Dealer Q Auto Repair <br />Q Trucking Fleet <br />Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />IS Used Tire Dealer Q Auto Body <br />Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler <br />Q Agriculture <br />Q Shredder Q Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V T A I HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />Q <br />Q <br />Other: § <br />Comments <br />Inspection Form included: <br />Comments included: <br />INSTRUCTIONS <br />White Copy: CalRecycle Yellow Copy: Operator <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />Q Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />N <br />R <br />N <br />0 <br />LU <br />LU <br />