Laserfiche WebLink
Waste Tire Survey& Inspection Repor1talnspection Report Number <br />!- Cal Recycle State of California <br />CalRecycle 181(Rev.10/10)Survey Form - Page 1 I11176708 <br />Dept. of Resources Recycling and Recovery (CalRecycle) <br />Part A - Survey BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID - Inspection Type (Fill one) <br />Site Suffix: -7 V ri 6 C ( 0 Routine 0 Re -inspection 0 Referral 0 Observation <br />LocalC � ,^ '�`�� �� If Referral, choose referral type (Fill one) <br />Identifier: ��C u' t 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br />Business or Facility Name <br />Inspected By Inspector <br />Physical Address n '� <br />6',8()Lj C. ,mv7-t'�-- '�*, . <br />Cav Ci,t-ov-' 6A R5d0-'5— <br />Business Rep Title <br />Tire Count (Whole/PTE) <br />GPS Latitude . <br />Longitude - <br />Inspection Date <br />- Z <br />Time In Time Out <br />*AM <br />1 S 0 P <br />Business Role Storage Type <br />(Fill all that apply) (Fill all that apply) <br />0 Generator 0 Outdoor <br />0 Hauler 10 Indoor <br />0 End -Use 10 Container <br />Business Type (Fill all that apply) <br />0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br />0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br />0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />10 AM <br />l t <br />5— Q PM <br />Operational Status <br />Tire Type <br />(Fill one only) <br />(Fill all that appl <br />0 Active <br />0 Passenger <br />0 Closed <br />0 Altered <br />0 Inactive <br />0 Truck <br />0 Planned <br />0 OTR <br />*AM <br />1 S 0 P <br />Business Role Storage Type <br />(Fill all that apply) (Fill all that apply) <br />0 Generator 0 Outdoor <br />0 Hauler 10 Indoor <br />0 End -Use 10 Container <br />Business Type (Fill all that apply) <br />0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br />0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br />0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />It I <br />A <br />HAULING AND MANIFEST REQUIREMENTS <br />�) <br />0 <br />PRC § 42951 - Waste Tire Hauler Registration and Transport of Tires <br />G <br />0 <br />PRC § 42953 - Contracts with Registered Waste Tire Haulers. <br />0 <br />0 <br />PRC § 42956 - Registration/Decal in Vehicle <br />0 <br />0 <br />14 CCR § 18459 - Responsible Entities Complying with Manifesting Requirements <br />0 <br />0 <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />0 <br />0 <br />14 CCR § 18459.2.1 - Submittal of Comprehensive Trip Logs within 90 days <br />0 <br />0 <br />14 CCR § 18459.3 - Retention of Comprehensive Trip Logs for 3 years <br />0 <br />0 <br />14 CCR § 18460.2 - Manifest System Requirements for Registered Waste Tire Haulers <br />0 <br />0 <br />14 CCR § 18461 - Manifest System Requirements for Waste Tire End -Use Facilities <br />0 <br />0 <br />14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators <br />0 <br />0 <br />Other: § <br />Comments <br />Inspection Form Included: Q%, ��� <br />Comments Included: ® 6 <br />Business Rep's Signature Phone Number <br />INSTRUCTIONS ON BACK Correct: Incorrect: x� <br />White Copy: CalRecycle Yellow Copy: Operator <br />Pink <br />�ENFORCEMENT STATUS__________ <br />0' Notice Of Violation 0 Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EX7) <br />0 Referred / CalRecycle Enforcement <br />W <br />® In Compliance - No Violations o <br />.rJ <br />Phone Number <br />62081 <br />