Laserfiche WebLink
Waste Tire Survey & Inspection Report Inspection Report Number <br /> CalRecycle State of California I 1 - 1230114 <br /> CalRecycle 181(Rev. (CalRecycle) Survey <br /> 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- +� Q ' O _ Q Inspection Type(Fill one) <br /> Site Suffix: o JC. <br /> 0 Routine 0 Re-inspection 0 Referral 0 Observation <br /> Local ��� If Referral,choose referral type(Fill one) <br /> Identifier: 0c-1 <br /> 1.ltn �t/(r1 �1 0 CHP 0 CalRecycle 0 Complaint 0 Educational Visit 0 Other <br /> Business or Facility Name _J Inspected By Inspector <br /> Physical Address -1 1 s.co L) <br /> lA. U nne- W <br /> n 5�� Inspection Date U <br /> U CA " Time In t Time Out <br /> Business Rep Titley AM 1 *AM <br /> C ` CIACV(�,S F u �(leAct"ilb k 0 5 0 PM l ` C� O PM <br /> C Operational Status Tire Type Business Role Storage Type <br /> Tire Count(Whole/PTE) r7 (Fill one only) (Fill all that apply) (Fill all that apply) (Fill all that apply) <br /> ' 46 Active 9 Passenger ® Generator 0 Outdoor <br /> O 0 Closed 0 Altered <br /> �PS Latitude 0 Hauler � Indoor <br /> O 0 Inactive Is 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 /> • ' •Used Tire Dealer 0 Auto Body 0 Car Dealer 0 Collection 0 Crumb Rubber <br /> '0 Service Station 0 Hauler 0 Agriculture 0 Shredder ® Other _(�40 f_C. _,N \1(44 <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 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 <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 EXE <br /> 0 0 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years <br /> 0 <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 T_ ' �Sj- r S , � +'1�5 (�z1 -1 j <br /> � I n <br /> l� n � L <br /> [i't�S (QGts 0i n of <br /> Inspection Form Included: 0 <br /> Comments Included: S \�t.yYf�•1•(�— '1 <br /> Hess ep s Signature Phone ftYrrrb4f Inspe or's Signature Phone Number <br /> INSTRUCTIONS ON BACK Correct: Incorrect: W E X A P E 1 2 3 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink C py EA ® ■ <br />