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Waste Tire Surrey & hispection Report SURVEY REQUIRED <br /> • tE72. <br /> i13.• State of Califomla M <br /> Cl4VMe 182' e ) <br /> California Integrated Waste Management Board Inspection Form � Page 2 <br /> Part C-Facility information _ BLUE OR BLACK INK PEN <br /> Business Profile �cc���}�{ inspection Details <br /> _ <br /> F._.._i_ - ) �NW R� Inspection --t---r—r— _Site SuTPID <br /> ffix: ^ ,1^G.1'7 16 I O i 2i Z.J L ._l� Report I j <br /> ` _T Number: L <br /> SWIS T , Inspection Number on the associated Survey form(Page 1) <br /> Number: I I !_ _� Photos Taken Yes Q No <br /> 1 <br /> Property Owner <br /> cA9, 4 <br /> xa: rU,ir JAGX' n. „e Z e <br /> Exempt Business Type (Fill if applicable) Permitted 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 0 Unpennitted <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 /> 0 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 0 14 CCR§18420 a (7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days 0 Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V1 A I WASTE TIRE STORAGE STANDARDS V I A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O(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 /> 0 0 PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier Q(2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit Q(a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit Q(b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan Q(d)Drainage <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement <br /> Q (f)Siting(New Facilities) <br /> 00 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures Q (h)Protection from Pyrolytic Oil Runoff <br /> Q(a)Communication Equipment Q (c)Water Supply 0 0 1 14 CCR§17356-Indoor Storage <br /> Q(b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> f2ol,-x, <br /> ._ At.�Q -^�..G. ©D�.�o--� Gou.�c.Q ►�o�J�G_'7_i�S -�s,�- -�.a�e.... <br /> INSTRUCTIONS ON BACK Correct:16 Incorrect: JE'JXJAJMJPJL1'E1 1112 3 15386 <br /> ■ White Copy:CIWMB Yellow Copy.Operator Pink Copy:LEA . <br />