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03 Waste Tire SL, 49y & Inspection Report .nspection Report Number ■ <br /> CalRecycle. State of California I 1 - 1242379 <br /> CalRecycle 181(Rev.y(CalRecycle) <br /> S I1 f1 Cha l/n�(/ IFou rCiifli o [P,3 g l I <br /> Dept.of Resources Recycling and Recovery(CalRecycle) 'mil I1 �Y IJ ll 11 9 �i <br /> PartA-Survey BLUE OR BLACK ONK PEN <br /> Business Profile Inspection Details <br /> TPID- I � ! Z 0 1 _ � 1 Inspection Type(Fill one) <br /> Site Suffix: -7b I 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: To U\h CC3`3 Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name <br /> Inspected By Inspector <br /> Physical Address <br /> 9y2 <br /> r Inspection Date 0 2 2 S / 1 <br /> ����G Time In Time Out 11 <br /> Business Rep Title ® AM \ [ AM <br /> 0 P J S QPM <br /> C.*--\en&_ AsSA-- <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 /> 9 Active Q Passenger 0 Generator Q Outdoor <br /> Q Closed Q Altered <br /> ��� Latitude Q Hauler 0 Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned 0 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 46 Other ",,j <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 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date 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 N <br /> a <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 <br /> c c� <br /> Inspection Form Included: Q / <br /> Comments Included: ® <br /> f4C <br /> Business Rep's Signature Phone Number Inspe or's Signatured!o� Phone Number <br /> INSTRUCTIONS ON BACK Correct:40 Incorrect: IEIXIAIMIPILIEI 11 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />