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rt Number Tire Survey & Inspection Report inspection Report <br /> 7 r� <br /> State of California Survey <br /> 1 I1 - 1226 %-) <br /> CalRecycle CalRecycle 181(Rev.10/10) *)urvey Form - Page <br /> Dept.of Resources Recycling and Recovery(CalRecycle) —BLUE OR BLACK INK PEN <br /> Part A- Survey inspection Details <br /> Part <br /> A- 52 e Inspection Details <br /> Business Profile Inspection Type(Fill one) <br /> Ro 0 i 0 Referral 0 Observation <br /> TPID- ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Site Suffix: <br /> If Referral,choose referral type(Fill one) <br /> Local <br /> Educational Visit 0 Other <br /> ocal C 0 CHP 0 CalRecycle 0 Complaint 0 <br /> Identifier: _XV,,� i, <br /> Business or Facility Name Inspected BY inspector <br /> C:1 - 1 0 1 Anz-vA lot) <br /> Physical Address <br /> So-1-1 E , inspection Date <br /> Time In AM Time Out AM <br /> Business Rep Title 1:P_ 0 PM 0 PM <br /> a e Type <br /> Type t <br /> Business Role Storage Type <br /> p I t apply) or apply)A , Operational Status Tire Type <br /> ( Y) <br /> I Y) Fill ly ;I ) (Fill all that apply) <br /> a that a (Fill all that apply) <br /> (Fill one only) ( all that apply) 11 <br /> Tire Count (Whole/PTE) 0?_ I*Active 0 Passenger ID Generator 0 Outdoor <br /> CIO 0 It M;" '. a I " <br /> 0 closed 0 Altered 'I r d <br /> Q Hauler indoor <br /> GPS Latitude 0 0 inactive 0 Truck 0 End-Use 0 Container <br /> Longitude 0 Planned 0 OTR <br /> Business Type(Fill all that�apply) 0 Government 0 Retreader Dismantler 0 Tire Derived Fuel <br /> New Tire Dealer Is Auto Repair U Trucking Fleet <br /> W <br /> 0 U <br /> 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 0 Notice of Violation 0 Extension <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires Compliance Deadline <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. <br /> 0 0 PRC§42956-Registration/Decal in Vehicle g Requirements Date / / m <br /> 0 14 CCR§18459-Responsible Entities complying with Manifesting <br /> m m <br /> 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle (Required for NOV or EX7) C� <br /> 0 0 Logs within 90 days <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip L <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 Referred/CalRecycle Enforcement <br /> 0 0 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers 2 <br /> Uj <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> for Tire Dealers or Waste Tire Generators in Compliance-No Violations <br /> 0 0 14 CCR§18462-Manifest System Requirements <br /> Other:§ <br /> 10 1 0 <br /> 0 <br /> 0 <br /> 0 <br /> HAULING <br /> P <br /> P <br /> A <br /> R <br /> R <br /> PRC <br /> C <br /> CL <br /> 4 <br /> 4 <br /> 4 <br /> N <br /> 2 <br /> 2 <br /> G <br /> 2 <br /> 95 <br /> 95 <br /> 95 <br /> A <br /> 1 <br /> 3 <br /> 6 <br /> AND <br /> Waste <br /> R <br /> a <br /> Registration/Decal MANIFEST <br /> Contracts <br /> gA <br /> e <br /> ra <br /> 't <br /> N <br /> T <br /> c <br /> I ra. <br /> Tire <br /> t <br /> tI <br /> r <br /> 0 1 8 <br /> s <br /> F <br /> e <br /> w <br /> E <br /> Hauler <br /> i <br /> a <br /> with T <br /> u I,' Tires <br /> ENFORCEMENT EN <br /> 0 C M <br /> 0 Notice Of V,_ <br /> 7. n D e' ing Requirements Compliance Dee <br /> go days <br /> C within 7da <br /> 4 CCR 45 -Responsible e <br /> 0 0 1 C §1 8 9 _ gr, <br /> 4 CCR 45 .1 Tire Pro <br /> 0 0 1 4 CCR§18459.2.1 -Submittal <br /> ears <br /> 0 0 1 4 CCR�j 8459.3_Retention y <br /> 0 0 1 4 CCR§1 8460.2_Manifest <br /> 0 0 1 4 CCR§1 8461 Manifest Sy <br /> Comments <br /> Inspection Form Included: 0 . 0673 <br /> Comments Included: 0 Phone Number I e or' ig t re Phone Number <br /> Business Rep's Signa 62081 <br /> INSTRUCTIONS ON BACK [Correct: Incorrect: ?ZQ( <br /> 0 White Copy:CalRecycle Yellow COPY:operator Pink Copy: <br />