Laserfiche WebLink
key & Inspection Report 0 <br />Waste Tire S p p inspection Report Number <br />Meccle State of California — <br />Y CalRecycle 181 (Rev. 10/10) I1 1242544 <br />Dept. of Resources Recycling and Recovery (CalRecycle)Survey Form -Page 1 <br />rl—. w c..-.,.... RI I IF OR RLAr_K INK PEN <br />Business Profile <br />Inspection Details <br />TPID -Inspection 5 _ D <br />` l <br />Inspection Type (Fill one) <br />Site Suffix: <br />0 Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Other <br />Local r 1 <br />Identifier: Satn JO(1.141 r1 �� <br />l J <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q <br />Business or Facility Name <br />1 <br />Inspected By Inspector <br />Physical Address <br />- 1es coryT 0 <br />M0. 4-4- <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />�O C� �SzoS <br />Inspection Date <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Time In Time Out <br />Business Rep Title <br />0 AM <br />0 AM 3L. 5 O <br />c <br />3 <br />(� <br />® PM J ® PM <br />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Q <br />Tire Count (Whole/PTE)r _ <br />lJ <br />(Fill one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />010 <br />0 Active <br />Q Closed <br />0 Passenger <br />Q Altered <br />® Generator <br />Q Hauler <br />® Outdoor <br />®Indoor <br />O <br />GPS Latitude <br />Q Inactive <br />® Truck <br />0 <br />Longitude - <br />Q Planned <br />10 OTR <br />Q End -Use <br />® Container <br />Business Type (Fill all that apply) Fu,kl <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 0 Other fwlf+4 iZAOI+ /Sr s <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />Q <br />Q <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />Q <br />Q <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />Q <br />Q <br />PRC § 42956 - Registration/Decal in Vehicle <br />Q <br />Q <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />Q <br />Q <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Q <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />Q <br />Q <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />Q <br />Q <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />Q <br />Q <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />Q <br />Q <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />010 <br />Other: § <br />Comments <br />(Z-1 ��-I n4 11 1f. Aeb . "1 \ ! I 1 �Sr]., . �rlL� , 1, 4 w S <br />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX/) <br />Q Referred / CalRecycle Enforcement <br />® In Compliance - No Violations <br />-dol\c9..���u��US ro�c�11► = - <br />�c�-Vi01Gl of �l.j�llS iAJlCrfn <br />Inspection Form Included: <br />�33 —o2aX - 104 <br />Comments Included: <br />yBn Ignature Phone Number Insp or's Signa re Phone Number <br />�,( 62081 <br />INSTRUCTIONS ON BACK Correct: Incorrect: zx W NJ E X A E 1 2 3 <br />White Copy: CalRecycle Yellow Copy: Operator Pink Cop L <br />N <br />0 <br />i <br />Lu <br />W <br />