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HAL__R OBSERVATION REPORT Observation Report Number <br /> CalReC cle IH-XXXX XX <br /> ,tcyce (Rev <br /> XXX) <br /> Dept.of R--Rejl iq and P--,cy BLUE OR BLACK INK PEN <br /> 0 TPID-not available/not applicable <br /> � Observation during inspection at: <br /> TPID- \ 7 3 IS-1 — p rj • Generator 0 End—Use Facility 0 Other: <br /> VehiclO e TPID- � 3 3 � 15_J_ <br /> Plate O <br /> State Observation in transit <br /> Decal Observation by Inspector <br /> Number <br /> (If Applicoble) <br /> Observation Date 1 3 <br /> 0 Hauler Exempt: <br /> Hauler Name Observation Time <br /> W�\4Scrt�, rcq�:Q`nhe� o� �reSnO ���� �j • � P, <br /> HaulerAddress <br /> PM <br /> Street <br /> City State Zip Code <br /> Driver's Namef <br /> D.O.B. <br /> t . <br /> Location of Observation <br /> Street .::. % <br /> 5�oc4�o� C 85205 For more information concerning Waste/Used Tire <br /> City State Zip Code Hauling&Manifesting, please call the Waste Tire <br /> Tire,l oad'.eount Hotline at(866) 896-0600. <br /> '(used+Waste).,', <br /> Part B- <br /> 4 <br /> 0 0 PRC§42951-Waste Tire Hauler Registration and Transport of Tires 0 0 PRC§42956(c)-Failure to Present Registration to Oficial <br /> 0 0 PRC§42952(b)-Falsely Represents Self as Registered Hauler 0 0 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 0 PRC§42956(a)-Registration/Decal in Vehicle • 0 14 CCR§18459-Hauler Complying with Manifesting Requirements <br /> 0 0 PRC§42956(b)-Hauler Using an Unregistered Vehicle 0 0 Other§ <br /> Comments 1 Driver's Statement: <br /> -----... ..._...__ ... _.--------- <br /> 'A kA <br /> ...ykA-2 C 5-0� ti1�til_2o�3�_.�ti �_ o.c;��. c ,zcQ <br /> \ <br /> -VSQ,Z _ *`' -.v2�r,�c,\e� �t o. o-��-.._ __._.'tis <br /> �2 r._ ,.��_�.-._1c�c►..��:e-�---�-'Z1r���.L�i�_hL__�nS_��2��Sca��._ ���'e..!n�-.___ ---- <br /> \\ _ rj{ 0-1,61 <br /> Y <br /> Comment Form I z tl U((j Q 4 <br /> Photos «�rE <br /> Driver's Signature Phone Nu . e Itt p�Gtoe, r�nat>lire Ptiona Numfier' ' <br /> Correct: Incorrect: �r <br />