Laserfiche WebLink
Waste Tire Survey & Inspection Repor ,, Inspection Report Number <br /> CalRecycle stat ecyclel181(Rev.10/10) <br /> Survey Form - Page 1 11 - 1177851 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A- Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- n Q C _ O ' Inspection Type(Fill one) <br /> Site Suffix: 3 1 7 40 Routine Q Re-inspection Q Referral Q Observation <br /> Local c '.^- If Referral,choose referral type(Fill one) <br /> Identifier: c�Ul� J O u-y uI 1\ /'W u Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name 1 <br /> (� n L 1 C J Inspected By Inspector <br /> Physical A1�\� \ G L\�1 L C 2'L 1 UI.Q 1�(n eJ'vll(k& _ a <br /> �U \9 1 funtL W(10� �;Tciuc. <br /> Inspection Date / O / <br /> Time In Time Out <br /> Business Rep Title nn O AM O AM <br /> d� O 0 PM O 0 PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) <br /> 1 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ® Active Q Passenger i Generator Q Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> C Q Inactive 9 Truck <br /> Longitude - Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair ® 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 Q Other <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 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires O Notice Of Violation Q Extension <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q Q 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <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 EXTJ <br /> Q Q 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q iQ 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 — W <br /> Q Q 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators <br /> in Compliance No Violations o <br /> Q Q Other:§ <br /> - z <br /> Comments Q _ ,�rj_ w� { . CmvA R" <br /> N <br /> Inspection Form Included: OI <br /> Comments Included: P q " 2, a <br /> iness ep's Signature Phone Number Ins tor's Signature Phone Number <br /> INSTRUCTIONS 4/BACK �Correct:ile Incorrect: ® � E X A L E 112 t3j <br /> 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Co Y. <br /> ® ■ <br />