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City/County Waste fire Survey and Inspection Report `taitin- Address c::: �, .– ��. C�,.v� ✓–, L r,�/, H �(.— Phone Number State of California CIWMB-54(10/03) PART A—General Information/Survey Page_of INSPECTION/SITE VISIT Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ ClWMB Referral ❑CHP Referral ❑ Other Facility SWIS: Inspected by: Time In: Date: Regulatory Sta s: File No. C] County/City / 7 ❑Permred Excluded❑Exempt❑ Unpermitted TPID: h o Code: Hauler ID: Time Out: Total Time: Operational Status: ❑ State L\1 ctive❑Closed❑ Inactive❑Planned Local: Business/Facility Name: TireCount: Typ Com' QPassenger❑Altered ❑Truck❑ OTR Address: Phone: Stopge Type C, �i� 0`f La-Z -Z�,�z Outdoof Indoor❑Container In pect (Pleas Pnnc): Business Rep: Owner: il Title: Facility Type:(check one) Role of Business:(check ail that apply) ❑ Major WTF(>5 coo tires) ❑ Minor%�iTF(>500 t:res) F-1WasteTire Location (<seo tires) L�/Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) re Dealer ❑ Reapply) r ❑ Dismantler ❑Auto Repair [I Auto Body ❑Car Dealer ❑Collection F1 Gas Station El Trucking Fleet C] Shredder ❑ Crumb Rubber ❑ Other: Describe Excluded Business Types(check only HAppiicable): ❑ 14 CCR§ 18420(a) (3) Facill:es storing less than 500 waste tires(Waste Tire Location). ❑ 14 CCR§ 18,420(a) (4) -Tire retreading fabl;y with no more than 3,000 waste tires on premises ❑ 14 CCR§ 18420(a)(6) - Auto dismantler storing no more than 1,500 waste tires for less than 90 days 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days If excluded from permit,complete Parts 8 and D I! excluded f-om permit requirements complete Parts 8.C,and D. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End Use Facility V A I C HAULING AND MANIFESTING REQUIREMENTS r " ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. ❑ ❑ 14 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. ❑ ❑ ❑ 14 CCR§ 18460.2 Manifest System Requirements for Registered Waste Tire Haulers ❑ ❑ ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ 14 CCR§ 18462-(Manifest System Requirements for Tire Dealers or Waste Tire Generators, PART C — Inspection of Waste Tire Facility 6 WAS'TETIRESTORAGE STANDARDSJ :tV, iA:�M 1 1fVA5TETIREST04ZAGESTANDARDS Permits Requirements [ [ [ 14 CCR§17352-Site Security ro ❑ ❑ PRC§42824–Major Waste Tire Facility Permit C1 (a)Signs C3(b)Site Attendant ❑(c)Access ❑ ❑I PRC§42834–Minor Waste Tire Facility Permit ❑ ❑ 01 PRC§42850(a)–Complies with Terms of Permit [ [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§ 18420(a) –Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 –Filing Application for Permit [ [ [ 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑(a)Storage Units ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§ 18432–Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433–Emergency Response Plan ❑(d)Drainage ❑ ❑ ❑ 14 CCR§ 18447–Records Available ❑ (e)Slope/Grade ❑ (f)Siting(New Facilities) [ ❑ [ 14 CCR§17351 -Fire Prevention Measures ❑ (g)Rim Removal ❑ (a)Communication Equipment ❑(h)Protection from Pyrolytic Oil Runoff ❑ (b)Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply 0 (d)Other Requirements Facility compliance wah NFPA 231 D-1 939