Laserfiche WebLink
02 Waste Tire SL. ,fey & Inspection Report Inspection Report Number <br /> CalRecycle State of California( 11 - 1177791 <br /> CalRecycle 181(Rev.10/1 0)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- 7 Inspection Type(Fill one) <br /> l <br /> Site Suffix: 1 g l $ 5 Q ® Routine Q Re-inspection Q Referral Q Observation <br /> Local . ' vl 't..� If Referral,choose referral type(Fill one) <br /> Identifier: 6z'v fcx Ct'/,V` 1 Q CHP Q CalRecycle Q Complaint Q Educational Visit Q Other <br /> Business or Facility Name Inspected By Inspector <br /> lJ�'i�� �C7LrtJrr✓S�'� 1 �VLG - S � n/� _ <br /> Physical Address 1 U f'�2�✓v11��1C� <br /> Inspection Date <br /> Time In Time Out <br /> Business Rep Title 0 AM r� 0 AM <br /> _ter l O O ® PM 40 PM <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 /> Q Active Q Passenger ® Generator Q Outdoor <br /> P$ <br /> Latitude O ® Closed Q Altered A11A <br /> CiQ Hauler Q Indoor <br /> 0 Q Inactive Q Truck <br /> Longitude - Q Planned ® OTR Q End-Use Q Container <br /> Business Type(Fill all that apply) <br /> Q New Tire Dealer Q Auto Repair Q Trucking Fleet Q Government Q Retreader Q Dismantler Q Tire Derived Fuel <br /> Q Used Tire Dealer Q Auto Body Q Car Dealer Q Collection Q Crumb Rubber nn // '/I/ <br /> Q Service Station Q Hauler Q Agriculture Q Shredder ® Other t� CJ ^� �-��7'bn V-'4'e <br /> Part B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ENFORCEMENT STATUS <br /> V A HAULING AND MANIFEST REQUIREMENTS <br /> - Q Notice Of Violation Q Extension <br /> Q Q PRC§42951 -Waste Tire Hauler Registration and Transport of Tires <br /> Q Q PRC§42953-Contracts with Registered Waste Tire Haulers. Compliance Deadline <br /> PRC§42956-Registration/Decal in Vehicle <br /> Q O 14 CCR§18459-Responsible Entities Complying with Manifesting Requirements Date m / / m <br /> Q Q 14 CCR§18459.1 -Tire Program ID Number from CalRecycle <br /> Q Q 14 CCR§18459.2.1 -Submittal of Comprehensive Trip Logs within 90 days (Required for NOV or EXT) n <br /> Q O 14 CCR§18459.3-Retention of Comprehensive Trip Logs for 3 years o <br /> Q O 14 CCR§18460.2-Manifest System Requirements for Registered Waste Tire Haulers Q Referred/CalRecycle Enforcement <br /> Q Q 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities w <br /> Q O 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators in Compliance-No Violations o <br /> Q Q Other:§ <br /> Comments /) n M tJ N <br /> wl 6z'yn� ) `tel cti c /�L o r r'1e✓172-vi� <br /> v s s j-r`J <br /> ke-H.l������✓tt�J\`[J-� �"lrr"�' �g�'��✓\t �Z G�.`�-'��1�� Q�XJ�2'a� - <br /> Gv mm enc-) ��� fi�°�o %-L 1 T6'18 t'S be- <br /> Inspection Form Included: O <br /> Comments Included: Q <br /> Business Rep's Signature Phone Number or's gnature Phone Number <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: X E X A L 1 I 2L3] 62081 <br /> ■ White Copy:CalRecycle Yellow Copy:Operator Pink Co :YL ■ <br />