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Waste Tire Sey & Inspection Rept SURVEY REQUIRE ' ■ <br /> ■ �W State of California -- <br /> CIWMB 182(New 04/04) Inspection Form - Page 2 -- - - <br /> California Integrated Waste Management Board <br /> Part C - Facilit Information BLUE OR BLACK INK PEN <br /> 1 :101 IN <br /> TPID_ r Inspection �- <br /> Site Suffix: Report <br /> '7 Number: �Ji-, <br /> ,° <br /> � (•-� <br /> SWIS m Photos Taken <br /> Number on the associated Survey form(Page 1) <br /> Number: I m Yes Q No <br /> CA / f <br /> SL 5 <br /> —. C7GI <br /> •, <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> O PRC §42823.5-Cement Manufactr ring 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) O Excluded ) Unpermitted <br /> 14 CCR§18420 a 2 Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill o•re <br /> Q 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises O 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 /> 14 CCR§18420 a 7 & e -Tire dealer storingno more than 1,500 waste tires for 90 days L Minor WTF (500 4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> 1. �'+ d, a .., , t f /'•/r ( �,;": <br /> Q Q PRC§42824-Major <br /> Waste Tire Facility Permit Q (a)Signs Q (b)Site. Attendant Q (c)Access <br /> 0 0 1`f <br /> Q PRC§42834-Minor Waste Tire Facility Permit CCR§ 'y353(a)'Vector Control <br /> Q (1) Impermeable Barrier Q (2)Approved Vector Plan <br /> I <br /> PRC§42850(a)-Complies with Terms of Permit'� � 14 CCR§1 354-Storage of Waste Tires Outdoors <br /> O O 14 CC•R§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit Q (b)Fire Lanes <br /> Q 0 14 CCR§18432-Operations Plan Q (c)Fire District Requirements <br /> Q (d)Drainage <br /> O O <br /> 14 CCR§18433-Emergency Response Plan <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> 0 0 14 CCR§ 18447 Records Available Q (g) Rim Removal <br /> � 14 CCR .w <br /> ures Q (h) Protection from Pyrolytic Oil Runoff <br /> Q a Communication Equipment Q (c)Water <br /> Supply ,CCR§17356-Indoor Storage <br /> Q (b) Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> '�1�-C'.�/�-'t,✓ ' ,Y '"P�.:p 67 7_(_�i 't_.C.'r �i.-e_ � .*.�r J�rt�< �� ��n�-r:7 b,_a••r _ <br /> Y.,' /'�'�_>(,_�. <br /> )�)r r`? �' �_ _40 r "�Z sFJa e <br /> INSTRUCTIONS ON BACK Correct:0 Incorrect: . �/; o, { r` � "�, T® ET a 3 15386 <br /> ■ __ _ ® ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />