Laserfiche WebLink
Waste Tire Surve & Inspection Re or Inspection Report Number <br /> CalRecycle y p p _ <br /> State of California <br /> Y CalRecycle 181(Rev.10/10) Survey Form - Page 1 1 1245269 <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� i _ � 7- � _ P~� /' Inspection Type(Fill one) <br /> Site Suffix: (.� �.J / 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local � If Referral,choose referral type(Fill one) <br /> Identifier: -�L�VI �� C�u Q CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or F�a�c`illliityy Name <br /> � Inspected By �l f Inspecc/torp, <br /> Ph��l ddress To-vi DyL� <br /> ;�--� SZ' � . Hire.►'nrrrn�.,�- L�2n�� - - <br /> �� - <br /> Inspection Date <br /> �S Zl U I <br /> Time In Time Out <br /> Business Rep TitleLL O AM _J 0 AM <br /> 6'PM Z S ® PM <br /> Ra--s I <br /> — Operational Status Tire Type Business Role Storage Type <br /> Tire Count hol PTE) <br /> (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> q' <br /> Active 0 Passenger 0 Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O 0 Inactive 0 Truck <br /> Longitude — 0 Planned 0 OTR 0 End-Use 0 Container <br /> Business Type(Fill all that apply) <br /> New Tire Dealer 6 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body * 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 ENFORCEMENT STATUS - <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> 0 Notice Of Violation 0 Extension <br /> O 0 <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m <br /> 0 0' 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT N <br /> a <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 0 Referred/CalRecycle Enforcement <br /> f <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities W <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators •Tn Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments /*�,.�,� <br /> 1 f CY-) 06o, oY1 <br /> Inspection Form Included: 0 4, 5 20e, <br /> Comments Included: 4LA�� J/7 �� <br /> Business Rep's Signature Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: EjXjAjMjPj LJEJ 1112131 <br /> 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />