Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number ■ <br />CalRec cle State of California <br />Y CalRecycle 181 (Rev. 10/10)11 Form -Page 1 I1 1177952 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />0w4 A _ C..winv BLUE OR BLACK INK PEN <br />Business Profile <br />Inspection Details <br />Type (Fill one) <br />TPID -Inspection <br />Site Suffix: -7 c/ ""� ( <br />® Routine Q Re -inspection Q Referral Q Observation <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other' <br />Local <br />Identifier: �CZ',VCb�� ��'L�j <br />Business or Facility Name <br />Inspected By Inspector <br />Ph ic. dre s� Vy�l <br />G t -y-cLYl1 K7��1 <br />-prw VV cjv'x�.�_ . <br />Inspection Date <br />Time In Time Out <br />Business Rep Title <br />Q AM O AM <br />L/ CP PM OPM <br />\ � <br />Operational Status <br />(Fill one only) <br />® Active <br />Tire Type <br />(Fill all that apply) <br />0 Passenger <br />Business Role <br />(Fill all that apply) <br />® Generator <br />Storage Type <br />(Fill all that apply) <br />® Outdoor <br />- - <br />- <br />Tire Count (Whole/PTE) �� © <br />O <br />��� Latitude <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />Q Inactive <br />Q Truck <br />O <br />Longitude - <br />Q Planned <br />Q OTR <br />®End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />® 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 ® Other ��� l✓u1Z�� <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 />Q Q PRC § 42956 - Registration/Decal in Vehicle <br />Q Q 14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements Date <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 EXT) <br />Q Q 14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <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 - <br />Q Q 14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators ®In Compliance - No Violations <br />Q Q Other: § <br />Comments <br />Inspection Form Included: Q li' 7 <br />y6fr 777�JOMpAtor's <br />Comments Included: <br />Business Rep's Signature Phone Number at a Phone Number <br />i� <br />I <br />INSTRUCTIONS ON BACK Correct: 0 Incorrect: EXnZUtSAM E 1 2 3 ■ <br />■ White Copy: CalRecycle Yellow Copy: Operator Pink Cop Qlar <br />y <br />