Laserfiche WebLink
Waste Tire Su, Bey & Inspection Report Inspection Report Number <br /> CalRecycle State of California - 1196541 ■ <br /> CalRecycle 181(Rev.10/10) Survey Form - Page 1 I1 119 6 5 41 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK IN_K PEN <br /> Business Profile Inspection Details <br /> TPID- '3 � � � - Q ` Inspection Type(Fill one) <br /> Site Suffix: 1 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: „� Johp V C5 Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> Tcr__ 7_o SeCv�C� 2> G� - C) <br /> Physi Address <br /> 7gLid .5. i�� Dnp a. <br /> C� Inspection Date I / / 1 3 <br /> Time In Time Out <br /> Business Rep Title ' 1C> AM 18 AM <br /> 5 O PM 3 O PM <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 /> 16 Q Active Q Passenger Q Generator Q Outdoor <br /> 0 Closed Q Altered <br /> GPS Latitude Q Hauler Q Indoor <br /> O Q Inactive Q Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q Other <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> Q Notice Of Violation Q Extension <br /> Q Q <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q Q PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date M / m / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q Q 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators •In Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments 4 \4s���,.n Gin .:.5 � �. c��c. '�r�. <br /> " :o -ovs oc A.cen�Sx\~^�c%C\ <br /> _Ab�es` ��,5¢��, � �.�cs o�5;fie..4�� aces;�.�ce..� c a� ►enc.������ <br /> 5����e,vse� �o e. :cP-S cs.� �,S S' s _ �• c L�se'C ]�. <br /> Inspection Form Included: Q <br /> Comments Included: <br /> Business Rep's Signature Phone Number Insp or's Signature Phone Number <br /> �( <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: g E X A M P L E 1 62081 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA © 0 <br />