Laserfiche WebLink
Waste Tire Su. ✓ey & Inspection Report Inspection Report Number <br /> CalRecycle State of cle181(R I 1 - 1210508 <br /> CalRecycle 181(Rev.y(Ca[ Survey Form - Page 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- i f G' - © Inspection Type(Fill one) <br /> Site Suffix: ` 1 o Routine 0 Re-inspection 0 Referral 0 Observation <br /> Localr '_ If Referral,choose referral type(Fill one) <br /> Identifier: sQ C1�Q CA,q 1/Lt� W tint 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name ll Inspected By Inspector <br /> I <br /> Tre, d- w�e� �3 o S <br /> �S coPhysical Address <br /> CA q s-LO5 Inspection Date 1 0 / / 3 <br /> Time In Time Out <br /> Business Rep Title O AM O AM <br /> l�\ i 1 S PM S e PM <br /> fl V 0 t� 0'U��' <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 /> /Y/ <br /> 0 Active 0 Pas ngg}e�r 0 Generator 0 Outdoor <br /> O ® Closed 0 Alt�d /t 1 V � <br /> GPS Latitude 0 Hauler/J4 0 IndooJA <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 /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet 0 Government 0 Retreader 0 Dismantler 0 Tire Derived Fuel <br /> 0 Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection . 0 Crumb Rubber <br /> 0 Service Station 0 Hauler 0 Agriculture 0 Shredder 0 Other N�� <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 /> 0 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 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / m / m <br /> 0 0 14 CCR§18459.1 -Tire Program ID Number from CalRecycle N <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) <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 /> 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 4i In Compliance-No Violations o <br /> 0 0 Other:§ <br /> z <br /> Comments S <br /> 2 n v� �r\c14) <br /> no�'c�l = u---V lCL <br /> -u,f�, ►�l s &,j n 1 Q i auil, <br /> I-4S 1A - C a Ss .i D <br /> Inspection Form Included: 0 C,T ) Q,/G - <br /> Comments Included: <br /> Business Rep's Signature Phone Number Ins or's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: W � E X A M P E 1112 3 62081 <br /> 0 White Copy:CalRecycle Yellow Copy:Operator Pink Copy:LEA ® ■ <br />