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HAULER OBSERVATION REPORT <br /> CalRecycle CalRecycle'775(New 2/14) <br /> IR­ ...R«y6mg dR«a,zry BLUE OR BLACK INK PEN <br /> Hauler Profile Observation Details <br /> O TPID-not available/not applicable • Observation during inspection at: <br /> Generator 0 End—Use Facility 0 Other: <br /> TPID- 1 8 2 1 2 6 9 — 0 1 <br /> TPID- 1 2 9 0 3 3 <br /> Vehicle State <br /> Plate O Observation in transit <br /> Decal Observation by Inspector <br /> Number m 3 9 — 1 0 1 I Xlong <br /> (If Applica- <br /> O Hauler Exempt: Observation Date <br /> Q Hauler name&address not known <br /> Observation Time <br /> Hauler <br /> •AM <br /> 1 1 4 2 0 pM <br /> Hauler Address <br /> 14090 <br /> Street ENFORCEMENT STATUS <br /> Alpine Rd <br /> City State Zip Code O Notice of Violation <br /> Lodi CA 95240 <br /> Compliance Deadline <br /> Driver's Name D.O.B. mm <br /> m / lam / m <br /> Location of Observation <br /> � Referred/Ca lRecycle, Tire Hauler Compliance Unit <br /> Street <br /> 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 O PRC§42956(c)-Failure to Present Registration to Official <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> O O PRC§42956(a)-Registration/Decal in Vehicle O 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 /> 1.)A search done on WTMS for"Delgado Tires" TPID# 1290336 from 09/30/2015 to present resulted in 80 <br /> manifests. Most of the manifests were available on site for review during the inspection. 14 additional manifests <br /> from "Izzy's World of Tires" TPID# 1821269 were available on site for review. <br /> 2.) The 14 additional manifests reviewed were not submitted to Cal-Recycle within 90 days of the load shipment. <br /> Comment Form O <br /> (209)468-2807 <br /> Photos Driver's Signature Phone Number Inspector's Signat Phone Number <br /> Correct : • Incorrect: X <br />