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'is-iil Waste Tire Ovey & Inspection R ,-� t SURVEY REQUIRED ■ <br /> ■ 1 State of California �a - _� <br /> CIWMedWast(New Manag) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C- Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details _ <br /> TPID- gg Inspection <br /> Site Suffix: Li 1 5 o l Report I 1 — 1 �"� 3 I S <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes 0 No <br /> Property Owner <br /> SilV i6. AnyLkAQ'no 8t�1. long ab3t Fo) cCc'_e C4 . S�oIJ Uf� <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 O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) i10 Excluded Q 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 /> Q 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> ,46 14 CCR 18420 a 7 & e -Tire dealer storingno more than 1,500 waste tires for 90 daysMinor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> VI A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 Q PRC§42824-Major Waste Tire Facility Permit Q (a)Signs Q (b)Site Attendant Q (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> Q (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> Q PRC§42850(a)-Complies with Terms of Permit O O 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 Q 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> Q 0 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 0 Q 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> Q (d)Drainage <br /> 0 0 14 CCR§18433-Emergency Response Plan <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available Q (g)Rim Removal <br /> Q 0 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment Q (c)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments ��nn <br /> r� c a mm —R V c, <br /> J,1�C-fec7 <br /> Gid cc!Q �nb -�-1r�a,n. ��►� c�.c.tI,, �e`S vt-gu 1 rc c <br /> 15386 <br /> INS d RUCTIONS ON BACK [Correct.�JIncorrect: ( R f? (r 1 3 <br /> - -- — <br /> ® White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® r <br />