Laserfiche WebLink
Waste Tire ey & Inspection Repot nspection Report Number <br /> CalRecycle state of California 11 - 1176520 <br /> CalRecycle 181(Rev.y[Cal Survey Form - Page 1 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> Part A-Survey BLUE OR BLACK INK PEN <br /> Business Profile i Inspection Details <br /> TPID- 1 R i Inspection Type(Fill one) <br /> Site Suffix: 1 ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local If Referral,choose referral type(Fill one) <br /> Identifier: Y� -�D�G ,�� 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name 1 (f - <br /> Inspected By Inspector <br /> Physical Addr s / tea._.,/__ a,��GLv <br /> I i �►rt �'iG'�=� I� <br /> j <br /> 200 JAI"rc�lti tti f�k. <br /> Inspection Date <br /> 1 GA 153T7 <br /> � Time In Time Out <br /> Business Ren Title c O AM O AM <br /> D • PM �/ 1 S ® PM <br /> J. <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count (Whole/PTE) i (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ` <br /> 2. 0 0 Active ® Passenger a Generator ® Outdoor <br /> 0 0 Closed ® Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> 0 0 Inactive 0 Truck <br /> Longitude - 0 Planned 0 OTR 0 End-Use ® Container <br /> Business Type(Fill all that apply) <br /> 0 New Tire Dealer 0 Auto Repair 0 Trucking Fleet ® 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 <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 I <br /> 0 0 PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> 0 0 PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> 0 0 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 <br /> 0 0 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EX ) <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 <br /> in Compliance No Violations o <br /> 0 0 Other:§ �_ <br /> Comments ' 14 i t �[a�l . �l�lClu✓ <br /> - - - - - <br /> Inspection Form Included: 0 y / <br /> Comments Included: ® /1 Yom` -- _;ho <br /> r ab Z <br /> —- -. <br /> Business ep s Signature one Number Inspectors Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: �JEX A I P L E 1 2 3 62081 <br /> White Copy:CalRecycle Yellow Copy:Operator Pink Cp : �� <br />