Laserfiche WebLink
M Waste Tire Survey & Inspection Report Inspection Report Number . <br /> Cal Rec cle State of California — <br /> Y CalRecycle 181(Rev.10/10) Survey Form - Page 1 1 1226330 <br /> Dept.of Resources Recycling and Recovery(CalRecycle) <br /> BLUE OR BLACK INK PEN <br /> Sart A- Survey- <br /> Business Profile Inspection Details <br /> TPID- , 1 _ O I Inspection Type(Fill one) <br /> Site Suffix: 1 u[ 1 * Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local ; If Referral,choose referral type(Fill one) <br /> Identifier: jf�� J Q(a,t� ��� C(�u� 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name 1 Inspected By Inspector <br /> �i <br /> Physical Address Sz �I Q 0 <br /> � ^ Inspection Date � / 0 <br /> f C&� � � 1 <br /> y +(�, i -5y7% Time In Time Out <br /> Business Rep Title a O AM u AM <br /> O A PM 1 0 o ® PM <br /> �l p <br /> v ` U &Nck � Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) L (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> U ® Active ® Passenger 0 Generator 4D Outdoor <br /> O 0 Closed � Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O 0 Inactive Truck <br /> Longitude - 0 Planned ® 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 ® 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 0 0 Notice Of Violation 0 Extension <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 /> 0 0 PRC§42956-Registration/Decal in Vehicle <br /> 0 0 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date <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 /> 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 /> 2 <br /> W <br /> 0 0 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities <br /> 0 0 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators •In Compliance-No Violations o <br /> 0 0 Other:§ <br /> Comments l_A1-f^,4,, 41,4, 1,(�iC�.Gt� 'vn <br /> J 1 , <br /> ��d 1I_1-c)_ISdL���S C� r C.t�.l'�•�S—j'�'' C.1 t.f1[ef(1 <br /> Inspection Form Included: <br /> Comments Included: <br /> #BA <br /> ss Rep's Signature P n mbe Inspe - is Signature hone Number <br /> 62081 <br /> INSTRUCTIONS KCorrect: Incorrect: � � E X A P L 1 2 3 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pin A �� ■ <br />