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Waste Tire JWey & Inspection Refit <br /> ' Stateof califomia <br /> crwB <br /> California lnte ^t dtWalsteNew Ma agel <br /> gmentBoard nspection Form - Page 2 <br /> Part C - Facility Information _ BLUE OR BLACK INK PEN <br /> Business Profile 'Inspection Details - - --- --- - <br /> TPID- Inspection <br /> Site Suffix: l - Q ) Report <br /> lNumber. <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: <br /> Photos Taken 0 Yes Q No <br /> Property Owner <br /> A-rvnavl& -t toil J010 1 &� 7�!G CIY r . M c-4 Y-I%k <br /> Exempt Business Type (Fill d - __ -_--•- - _.._.-..__ 1-._ <br /> _ _ _ _ applicable) -- - --- Permitted Regulatory Status (Fill one) <br /> Q PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption -- <br /> Excluded Business Types(Fill if applicable) ..._.._.. -- _-- • -- • Q Permitted Q Exempt <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) J' - <br /> • Q Excluded 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 C CR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste fires on premises <br /> Q Major WTF (>-5,000 Tires) <br /> Q 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste fires for less than 90 days <br /> .Q 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 /> Permit Requirements <br /> 00 14 CCR§17352-Site Security <br /> --- - <br /> Q Q PRC§42824-Major Waste Tire Facility Permit Q (a)Signs Q(b)Site Attendant O (c)Access <br /> 0; 01 PRC§42834-Minor Waste Tire Facility Permit Q 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O (2)Approved Vector Plan <br /> 0, 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 01 Q 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units _ -- - -- -- <br /> Q Q , 14 CCR§18423-Filing Application for Permit I O (b)Fire Lanes <br /> Q I 014 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> Q j O 14 CCRcyposse Plan§18433-Emerges Res O (d)Drainage <br /> -._- -- ... <br /> Recordkee ing RequirementO (e)Slope/Grade_ <br /> O (f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures 0(h)Prdtection from Pyrolytic Oil Runoff <br /> - - - -- - t _ <br /> --• .. - _�r -... __ __ _.. - - - <br /> (a)Communication Equipment Q (c)Water Supply 00 14 CCR_§17356-_Indoor Storage J <br /> O (b)Fire Equipment O (d)Other Requirements - Facility Compliance with NFPA 231 D-1989 - <br /> Comments <br /> see <br /> 1117�.INSTRUCTIONS ON BACK ?C <br /> '- �,. 15386 <br /> s Jf. R M P, E=, 11 Z 3 <br /> Whit Yellow Copy.Operator Pink Copy.LEA <br />