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AWL <br /> Waste Tire vey Inspecti®n � t�'�. �,d t <br /> ■ 1'_'.&,:A <br /> I SURVEY REQUIRED <br /> State of California — J <br /> CIWMB182(New 04/04) <br /> California Integrated Waste Management Board Inspection Form - Page 2 BLUE OR BLACK INK PEN <br /> Part C-Facili Information _ _ <br /> BInspection Details <br /> Business Profile <br /> Inspection C� <br /> - ` Lj l t �l /L 0 1, Report <br /> Site <br /> Site Suffix: �( Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> SWIS <br /> Number: Photos Taken Q Yes JPNo <br /> Property Owner <br /> Type Fill'rf applicable) <br /> Permitted Regulatory Status (Fill one) <br /> Exempt Business Typ. ( <br /> Q 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) ®Excluded Q Unpermitted <br /> Q 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 Q Major WTF (_>5,000 Tires) <br /> Q 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days Q Minor WTF (500-4,999 Tires) <br /> 14 CCR 18420 a 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 da <br /> Part D-Inspection of Waste Tire Facility _ _ _-------------- <br /> V A WASTE TIRE STORAGE STANDARDS_ V A — <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit (a)Signs (b)Site Attendant (c)Access <br /> 00 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> Q Q PRC§42850(a)-Complies with Terms of Permit 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q O 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> Q Q 0 (b)Fire Lanes <br /> 14 CCR§18423-Filing Application for Permit <br /> 0 (c)Fire District Requirements <br /> Q Q 14 CCR§18432-Operations Plan 0 (d)Drainage <br /> Q Q 14 CCR§18433-Emergency Response Plan 0 (e)Slope/Grade <br /> Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> Q Q 0 (h)Protection from Pyrolytic Oil Runoff <br /> 14 CCR§17351-Fire Prevention Measures <br /> 0 (a)Communication Equipment 0 (c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> ® -– / E—E 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect �/ E A P �- I ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />