Laserfiche WebLink
Waste Tire 6urvey & Inspection Repan Inspection Report Number <br /> CatRec cle State of California <br /> Y CalRecycle 181(Rev.10/10) �urVey Form - Page 1 I 1 - 1245387 <br /> Dept of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Surve BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- � _ � ( Inspection Type(Fill one) <br /> Site Suffix: 1 0 Routine Q Re-inspection Q Referral Q Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: aL rl 0 CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> � C off— OCLL_L� ►t-- �Z -e-0 <br /> Physical Address <br /> l CLOG u_tl� Alba, <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title O AM Z7 O AM <br /> Z ' � � 0PM 13 ' L � ® PM <br /> V DYti 1U iJ11,t Z SaL0 0aor� <br /> �16perational 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 /> Xr e Active 0 Passenger 9 Generator Q Outdoor <br /> D Q Closed 0 Altered <br /> GPS Latitude <br /> o Q Inactive &Truck Q Hauler O Indoor <br /> Longitude — Q Planned O OTR O End-Use O Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer O Auto Repair Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body O Car Dealer Q Collection Q Crumb Rubber <br /> Q Service Station Q Hauler Q Agriculture Q Shredder Q Other �►� .. iTl/ ✓ <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 � Extension <br /> O O <br /> PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> Q 0 PRC§42956-Registration/Decal in Vehicle <br /> Q 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <br /> 0 Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXE N <br /> a <br /> - N <br /> 0 O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> 0 O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Uj <br /> w <br /> O O 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> O O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators 0 In Compliance No Violations o <br /> O O Other:§ / - Z <br /> Comments '(7 ,, �,i�� l.t�.2JS�.l. ��-Q- •f K�Pa2JLt�L1��, �lt� Uyl_.. '�'�Gr� L'�C�t �, <br /> Inspection Form Included: Q <br /> Comments IncludeAh <br /> d: <br /> i �aOQ)$58-ylra 7.LPI� 4'cak-� <br /> Business Rep's Signature Phone Number Inspector's Signature Phone Number <br /> INSTRUCTIONS ON BACK I Correct:* Incorrect: IEIXIAIMIPILIEI 1112 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />