Laserfiche WebLink
HAULER OBSERVATION REPORTObservation Report Number <br /> Ca1Rec cle Statearcatirw" I IH-XXXK>= <br /> l:a3Ei ecycle XXX(Rev X=) <br /> D�;, .za dR.=—y BLUE OR BLACK INK PEN <br /> $ 9',5 �� <br /> Oa TPID-notavailabletnot applicable <br /> Q Observation during:inspection at: <br /> TPID- ❑—� N Generator p End—Use Facility p Other.f o o ® ©' 1 O 1 <br /> mID= 6 7 g lei <br /> Vehicle State <br /> Plate Q Observation in transit <br /> DecalObservation by Inspector <br /> Number F q — �I .M Afi-1 V <br /> (Upplicabla) <br /> Observation Date ©' <br /> O Hauler Exempt <br /> Hauler Name Observation Time <br /> 6cC"\e—AV, LO's":ce-00,eS-ak`wn•5,W'c ft p ; M35, <br /> ! 'w <br /> Hauler Address aµ <br /> 233 gelle.v�e { <br /> Street <br /> Cjan� L-ds*_ cf <br /> City State Zip Cbde p r <br /> Driver's Name D.O.B. 5 <br /> Location of Observation <br /> Street <br /> For more information concerning Waste/Used Tire <br /> city s a Tip code Hauling&Manifesting,please call the Waste Tire <br /> xt re t-o dr ❑ '" Tk Hotline at($66) $96-0500. <br /> rw <br /> Part B - <br /> owl , : <br /> O Q PRC§42951-Waste Tire Hauler Registration and Transport of Tres O 0 PRC§42956(c)-Failure to Present Reglstratlon to 6mclat <br /> 0 O PRC§42952(b)-Falsely Represents Self.as Registered Hauler Q 0 14 CCR§.18456.4—Failure to Abide by Temporary Registration <br /> O O PRG§42956(a).-Registratlon/Decal in Vehicle ! G 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> Q Q PRC§4.2955(b)-Hauler Using an Unregistered Vehicle Q G Other§ <br /> Comments I Driver's Statement: <br /> �pv�:�_t�,.-3w �a-c•�4...s�.__.N�'���r.,��c.Sj.c�Z�„�'�-n,�.__a�..`.� L�67�9`�1�1`.� —�. . ---.._..I--------------- <br /> -_S�,e.:. <br /> Yee <br /> ,� �,n+4t1y3�- ..,a,. <br /> 0 c Qnt Form <br /> Y� lilt's;rd�f�41n]]] ir.S'v1� 'sy�4trt. <br /> 1 Ir <br /> Phone Nei rr� '.II - Qf't�. c n red Plao e Nurrtt?e4 <br /> tgnature y 1 �'?t " ? {,xl, <br /> r e_a,: +?A7 at l. $ i L�`4k 1 .{ <br /> Correct: Incorrect: �i <br />