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. _ 2, Waste Tire 3I+ey & Inspection Bert [SURVEY REQUIREDState ofCalifornia ■ <br /> CI MB Integrated <br /> stemanag) Inspection Form - Page 2 <br /> California Integrated Waste Management Board p J <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID <br /> Lf/ <br /> - + / _ Inspection <br /> Site <br /> Site Suffix: 1 �,J V ' j � � � Report I � _ i U ' -317 !_'\ b <br /> Number: 1 <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken t Yes 0 No <br /> EEI _ T <br /> Property Owner <br /> DG qv -log I PO W o?9 Sbce1-brt CSI g g aol <br /> Name s NAJ pAJ -rE- l <br /> .�00 p Phone umber Mailing Address City State ZIP Code <br /> Exempt Business Type (Fill if applicable) iPermitted Regulatory Status (Fill one) <br /> 0 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) 0 Excluded (C) Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast FacilityType(Fill one) <br /> 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 CCR§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 n Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V I A_ j WASTE TIRE STORAGE STANDA__R_DS 7 V A <br /> Permit Requirements 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 PRC§42834-Minor Waste Tire Facility Permit 0. 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> f 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit <br /> (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit (D (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> (d)Drainage <br /> 0 1 oil 14 CCR§18433-Emergency Response Plan 0 <br /> O (e)Slope/Grade <br /> Recordkee ing Requirement 0 (1)Siting(New Facilities) <br /> 0 <br /> 14 CCR 18447-Records Available 0 (g) r 0 § Rim Removal <br /> 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements I Facility Compliance with NFPA 231D-1989 <br /> Comments ctVid ' 3r_-'-'30 /J.. W t' :�UVI IjAtl bb+� !n 3-t-ockJoki iCfn /fft hot e Y10f <br /> orurr ►aK1 Gid �c( <br /> on �t/�7��l pec�tiDn#r �l�l 757. <br /> Site VisAh'15� revec (M '+k&+ *10.(-e �Clf7 coo -t+res are on Site' <br /> jhte►,dQc (r re f r�ctcl i :.Same of 4�6ese iris ✓2 2 s keo( Mrs r pew- <br /> li=� Vh S40y"My1a-"/' f?+ey,4/gin Aoy)d �kvtt�4'r vigJel� 5'�0de -n04r <br /> � - <br /> tan VJe✓e noq- S footAt sired in ale s QEva mat onlply G, <br /> c alp �lasie T r e Sfand(Avds4A o , A fiee Apid -{-an 'm W6d' ✓ <br /> weirs �S�orQd in 5;44066q afel' r were ire Veq qc�4ion of Y)Pczr �)(2VAwi � G►1e,. <br /> r U � I� 15386 <br /> INSTRUCTIONS ON BACK Correct:� Incorrect: ) � .�,;;��, {� L � � � ;� <br /> ■ White Copy:CIWM8 Yellow Copy:Operator Pink Copy:LEA ® ■ <br />