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��� Wastea Tire *Vey & Inspection Re SURVEY REQUIRED:E_ State of IN <br /> �9 CIWMB182e ) <br /> California Integrated Waite Management Board Inspection Form - Page 2 <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile 'Inspection Details <br /> TPID- Inspection ! <br /> Site Suffix: 14131 Report <br /> Number: 0m <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m Photos Taken 0 Yes Q No <br /> EE Property Owner <br /> 7 L I &D ii W` tJ V vi ! J dJ <br /> Name Phone Number Mailing Address city State ZIP Code <br /> Exempt Business Type (Fill if applicable) ! Permitted Regulatory Status (Fill one) <br /> 10 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) S Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> 0 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises 0 Major WTF (>5,000 Tires) <br /> 0 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days Q Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A l _ <br /> Permit Requirements 0�0 14 CCR§17352-Site Security _ rn <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit I Q Q. 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier O (2)Approved Vector Plan <br /> I1 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit <br /> O (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit O.(b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkee2ing Requirement <br /> O (f)Siting(New Facilities) <br /> �0� 0 1 14 CCR§18447-Records Available O (g)Rim Removal <br /> I <br /> 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment O (c)Water Supply I Q 014 CCR§17356-Indoor Storage <br /> b)Fire Equipment (d)Other Requirements Facility Compliance with NEPA 231D-1989 <br /> Comments Ire `7"r1GC W ale Akc K it/t ; r- L'k) c I iur _jj 1'10 <br /> �_ -1 r. Gi i/rt.� a �� {�,- /0 S �7 c7� a i�► G t< I A k <br /> AL 112, x� <br /> 1 A G 14 CCS �� SI i�� reg 14tr Pa St1KP S -- I`" w�vve <br /> C' ►� akiid L�a�; isr'� a tAuikvi lAi 5QlVeAt -to 'q0 fy� a u>�t <br /> r <br /> • r —1 L 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: �� � E� �,!;��', P � �' �� <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />