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HA, F_R OBSERVATION REPORT Observation Report Number <br /> CalRec cle SweofCalifornia IH-XXXXXXX <br /> Y CalRecycte XXX(Rev xxx) <br /> Dept dFtaourccs Ra-ycligg and Recovery BLUE OR BLACK INK PEN <br /> O TPID-not available/not applicable /1 <br /> ® Observation during inspection at: <br /> ® Generator 0 End—Use Facility 0 Ot�r: <br /> TPID- ' ":a ,� � �' '.�.&' C,� � gT-11 <br /> Vehicle n TPID- ➢ (� �I _ l <br /> Plate I I State O Observation in transit <br /> Decal Observation by Inspector <br /> Numbere" `.. — <br /> (If Applicablo) <br /> Observation Date <br /> Q Hauler Exempt: <br /> Hauler Name Observation Time <br /> ® AM <br /> �� �eGo✓ cJ�- > <br /> Hauler Address l 0 PM <br /> ,,gg' l . 1 u <br /> City State Zip Code <br /> Driver's Name D.O.B. W. <br /> Location of Observation <br /> X25 3�1 c..�G..��• o '� .� <br /> fleet lO —^`t Y�'w„t.. ;: �l y{ .<w•a_ :r, i�t }w tt' <br /> For more information concerning Waste/Used Tire <br /> city state zip code Hauling&Manifesting,please call the Waste Tire <br /> Hotline at 866 896-0600. <br /> ;Tire:Load Count H <br /> :� � } <br /> (used+waste , <br /> Part B- F <br /> ,lt? O.� .wf:sv RM <br /> e.r. ..i;�S..T� _• k4} �r.at>u�'zn'. <br /> O O PRC§42951-Waste Tire Hauler Registration and Transport of Tires O O PRC§42956(c)-Failure to Present Registration to Oficial <br /> O O PRC§42952(b)-Falsely Represents Self as Registered Hauler O O 14 CCR§18456.4—Failure to Abide by Temporary Registration <br /> 0 O PRC§42956(a)-Registration)Decal in Vehicle Q O 14 CCR§18459-Hauler complying with Manifesting Requirements <br /> O O PRC§42956(b)-Hauler Using an Unregistered Vehicle 4D Q Other (— <br /> Comments/ Driver's Statement: <br /> L`-L - '�--= - -�• ..� _ __ <br /> ���•_�3_nod-_._..1.;,���'��g...G���^_wt��t.l_.�a.�_ v. �}�____---- <br /> 02 <br /> Comment Form �r41 '� kf�• rT., �`} <br /> ?� <br /> Photos Q prlver's Signature Phone IVutZec r r I p; or' .$I�nafure Phone Nurra�er <br /> Correct: Incorrect: �r <br />