Laserfiche WebLink
0 0 Waste Tire Sup ,iey & Inspection Report inspection Report Number <br />CalRecycle state of California 11 -1210127 <br />CalRecycle 181 (Rev.10/10 <br />(Cal <br />Dept. of Resources Recycling and Recovery (CalRecycle)Survey Form - Page I <br />)art A - Survey BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />TPID -Inspection � � � � � _ � ' Inspection Type (Fill one) <br />Site Suffix: 1 * Routine Q Re -inspection Q Referral Q Observation <br />Local �, <br />Identifier: 50k-y,\J C9 V i� ��,n�J <br />If Referral, choose referral type (Fill one) <br />Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br />Business or Facility Name <br />/ <br />Inspected By Inspector <br />co \ a CC"_Qkke_ <br />Physical Address <br />Q <br />Q <br />2� 6o S • �t ��nwa �c q cl <br />Q <br />- - - <br />SInspection <br />Q <br />Date <br />14 CCR § 18459.1 - Tire Program ID Number from CalRecycle <br />Q <br />Time In Time Out <br />Business Rep Title <br />/"�Gl•1r��QY10. <br />iia <br />AM C AM <br />I O 0 PM 1 J Q PM <br />1�C1�� ets <br />-w <br />e� <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 />Operational Status <br />Tire Type <br />Business Role <br />Storage Type <br />Tire Count (Whole/PTE)(Fill <br />one only) <br />(Fill all that apply) <br />(Fill all that apply) <br />(Fill all that apply) <br />0 Acchve -. <br />Q Passenger <br />0 Generator <br />0 Outdoor <br />GPS Latitude <br />o <br />Q Closed <br />Q Altered <br />Q Hauler <br />Q Indoor <br />0 <br />Q inactive <br />• Truck <br />Longitude — <br />Q Planned <br />Q OTR <br />Q End -Use <br />Q Container <br />Business Type (Fill all that apply) <br />Q New Tire Dealer Q Auto Repair Q Trucking Fleet <br />Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br />Q Used Tire Dealer Q Auto Body Q Car Dealer <br />Q Collection Q Crumb Rubber <br />Q Service Station Q Hauler Q Agriculture <br />Q Shredder .Other <br />Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility <br />V F -A-1 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 />ENFORCEMENT STATUS <br />Q Notice Of Violation Q Extension <br />Compliance Deadline <br />Date m / m / m <br />(Required for NOV or EXT) <br />Q Referred / CalRecycle Enforcement <br />Q Q 14 CCR § 18462 -Manifest System Requirements for Tire Dealers or Waste Tire Generators Len Compliance No Violations <br />Q Q Other: § <br />Comments <br />Inspection Form Included: O <br />(V)Comments Included: ! � - ��� <br />Busines ep's Signature Phone Number Inspect is Signature <br />INSTRUCTIONS ON BACK [Correct: IS Incorrect: X (i�) VIIEIXIAIMIPILIEI1112 3 <br />White Copy: CalRecycle Yellow Copy: Operator Pink Copy: LEA <br />Phone Number <br />62081 <br />e <br />N <br />a <br />Uj <br />W <br />