Laserfiche WebLink
Waste Tire SL. ojey & Inspection Report Inspection Report Number <br /> State of Californiaal Recycle ia 11 - 1177869 <br /> CalRecycle 181(Rev.y(Ca[ Survey Form ® gage 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ` T-7 p _ Q Inspection Type(Fill one) <br /> Site Suffix: 1 ( 1 0 Routine Q Re-inspection Q Referral 0 Observation <br /> LocalI If Referral,choose referral type(Fill one) <br /> Identifier: Sup J ootl u f) couni l� Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name J Inspected By Inspector <br /> PhysicalA d s (1 <br /> C � <br /> a � 5p E _ Nbiff, (-I1CT - <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title ((�� 0 AM c O AM <br /> V <br /> I I ' 3 0 P 0 J ® PM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> 9 Active 0 Passenger 0 Generator Q Outdoor <br /> O Q Closed Q Altered <br /> GPS Latitude Q Hauler ® Indoor <br /> O Q Inactive Q Truck <br /> Longitude — Q Planned Q OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer 0 Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body 0 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 Notice Of Violation Q Extension <br /> Q Q <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <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 N <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) N <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 /> LU <br /> W <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 <br /> ®In Compliance-No Violations o <br /> Q Q Other:§ <br /> (� � ���� <br /> Comments (L\)U6� 110,NAD CI_ « 1,nSQ91V1k)n 66*)p— Ute` � �((�7 c� wt)A Ae, <br /> tnt Al () (.t,S _!l� C'_ <br /> J <br /> 00 VOAA"i'-P b3 U%eus Ian(trn - <br /> Inspection Form Included: Q <br /> ICZZL661)LvaluzComments Included: Y <br /> Business Rep's Signature Phone Number In�OrlsurePhone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: IEIXIAIMA L E 1112131 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Co y: ® ■ <br />