Laserfiche WebLink
Waste Tire Survey & Inspection Report -inspection Report Number ■ <br /> CalRecycle State of California 11 - 1242488 <br /> CalRecycle 161(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 Inspection Details <br /> TPID- ` O Inspection Type(Fill one) <br /> Site Suffix: l 1p "1 _1 V ® Routine 0 Re-inspection 0 Referral 0 Observation <br /> LocalC If Referral,choose referral type(Fill one) <br /> Identifier: JQrI t,,I'rl r`V 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name Inspected By Inspector <br /> '�' � H - l l <br /> Physical Address 3 5 o <br /> a�Ao(o L <br /> rC��O Q Inspection Date <br /> 5 / 0 a U <br /> �6� ZO Time In Time Out ) <br /> Business Rep r Title AM qAM <br /> O QPM � I QPM <br /> Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) r 1 5 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> vh 0 Active 0 Passenger 0 Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> GPS Latitude 0 Hauler 0 Indoor <br /> O 0 Inactive ® 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 <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 0 / 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 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 /> f <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:§ \ r <br /> Comments r� 1 . f, • _ �,n,,� / �—� 1'�3 �U��. (�Inspection Form Included: 0 / _3 <br /> 17 <br /> Comments Included: ® �" -- <br /> BusinesQRepSifnature Phone Numbe Inspe is Signature Phone Number <br /> n� 62081 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: EXAM 71 1 2 3 <br /> 0 White Copy:CalRecycle Yellow Copy:Operator Pink Co y: �� ■ <br />