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� f Waste ire Survey and Ins ection Reort City/county :N 3' P Mailing Address one Number State of California zyco-�.k AWIN-0, �4 CIWMB-54(10/03) V' &0t, ,PART A—General Information/SurveyPage L of 2 INSPEC710NfStTE�IISfT_ Type(Check one): E?J-Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other. Facihtys SWIS Inspected by Time In: Dat Regulatory Status: File No 6 /City i` ( - ❑Permitted &Excluded[I Exempt ElUnpennitted TPID. 05315 Hauler ID:tT,r�yq.. .v.. ❑'State Time Out. otal ime _;Operational Statur., i1 Local: [ 6cbve❑Closed❑Inactive❑Planned _ M�M- 1, Business/Facility Name: ` Tire Count Type: � � -`k ;�0.. 'BPassenger[]Altered[]Truck❑OTR en _ Phone: Adrs StorageType t� �y ; , ' a `� S S ,� 3 3�' �Outdoor❑Indoor❑container �4 b Owner: Inde tor Please Print): Business Rep: tie: Facili T ctxeckone) Role of Business: jdheckauttni.ppb ❑Major WTF(>s.000;ares) c❑Minor WTF(>soo tires) [-Waste Tire Location (<500 tires) �4Genefator ❑ Hauler ❑End-use Business,Type:(Check all that appb) ' 45-3 re Dealer ❑ Retreader ❑Dismantler Auto Repair ❑Auto Body ['scar Dealer ❑Collection ❑Gas Station ❑Trucking.-Fleet ❑Shredder ❑ Crumb Rubber ❑Other:Describe Excluded Business Types(6"o,n)ynXpPlicatiie);`•. ❑ 14 CCR§ 18420(a)(3)-facilities.storing less than 500 waste tires (Waste Tire Location). ❑ 14 CCR§ 18420(a)(4)-Tire retreading facility 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)8(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from perms,complete Parts B and D. If not excluded from permit requirements comttece Parts B.C.and D. PART B—Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility t:1f 'A :C � ^" 'r -H HAULING AND MANIFESTING REQUIREMENTS h�-(e�' "s'' �" ?tr:L;—; 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. j ❑ ❑ ❑ 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. ❑ ❑I ❑ 14 CCR§18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑1 [11 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑I [11 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C—Inspection of Waste Tire Facility j 0 ,. talt _RESTORAGDARD _P.ermits Requirementstl_'� 14CCR',§;17352=Site_Sewrftjr}' ' A ❑ ❑ ❑I PRC§42824-Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)-Complies with Terms of Permit _ "•[¢ FES`14CCf2§17353'{a'=41%cCoiitrtii , ❑ ❑ ❑ 14 CCR§18420(a) -Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§18423 -Filing Application for Permit =[ -`C Ta 414`.CCR§17354 ;StorWase;7ires Outd6*, P 9 4 . �. ❑ (a)Storage Units "s .Recordkee in . Gi 6hre `= ❑ (b)Fire Lanes C] ❑ C] 14 CCR§18432-Operations Plan El (c)Fire District Requirements ❑I ❑ 1 01 14 CCR§18433-Emergency Response Plan [I (d)Drainage ❑ C] ❑ 14 CCR§18447-Records Available El (e)Slope(Grade �� ,_ ❑ (f)Siting(New Facilities) .❑ �[ `14 CCR§17351' Fire"Prevention Measures' <r .- ❑ (g)Rim Removal ❑ (a)Communication Equipment ❑ (h)Protection from Pyrolytic Oil Runoff ❑(b)Fire Equipment [ [ '[' 14 CCR§17356 m;Indoor-Storage ❑ (c)Water Supply f [I (d)Other Requirements Facility compliance with NFPA 231D-1989 i I I I