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Waste Tire Survey & Inspection Report '" <br /> Waste <br /> California <br /> CIWMa W Ne anaI ) Inspection Form - Page 2 <br /> • <br /> Odin tegrated Waste MManaggement Board <br /> Part C-Facility <br /> acili Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details. <br /> TPID- q t� Inspection <br /> Site Suffix: l (2 a Z t � , Report <br /> Number: ` V <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - Photos Taken Q Yes Q No <br /> Property Owner <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status(Fill one) <br /> O PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption Q Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) . <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded Q Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> Q 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises MaJor WTF (?5,000 Tires) <br /> Q 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 Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit O(a)Signs O(b)Site Attendant O(c)Access <br /> O O PRC§42634-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> O O PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> Q '® 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> O Q 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> 0 O 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> O O 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)Slope/Grade <br /> Recordkeeping Requirement <br /> O(f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available O(g)Rim Removal <br /> 0 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply 10 O 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d()Other Requirements Facility Compliance with NFPA 231D-1989 \ <br /> Comments MIG 5�r c.t. `�^ [ 5 w T�v K D� � Cz l v 5 I <br /> *, <br /> L �-1 s'j�, �( <br /> w� S L1n J11- {'alt b�e 1 54 h,L W t OU_' <br /> 1 � P�-ly�►�T CSL P IT o�L C�S� �'I �'i�-(_. <br /> o• <br /> . : <br /> , 15386 <br /> INSTRUCTIONS ON BACK _. EIX M p L E: 1� <br /> ■ White Copy.CIWMB Yellow Copy Operator Pink Copy:LEA ® ■ <br /> 0529205.0024 <br /> I <br />