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Waste Tire Avey & Inspection Relart SURVEY REQUIRED <br /> ■ - State of California _ ■ <br /> rornia Inspection Form - Page 2 <br /> -,.„,-�1 CIWMB 182(New 04/04) <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> �TPID- _ Inspection <br /> Report �c Q <br /> Site Suffix: D�L 0 Number: <br /> SWIS - m Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken 0 Yes ® No <br /> Ll <br /> Property Owner <br /> ----- — I-77 _Z Murch,., F�k�,�u i_�a1�,ro CA._ <br /> gone Number Mailing Address <br /> r i 1 �'?n - - <br /> 9r� <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Slates (Fill one <br /> 0 PRC §42823.5-Cement Manufacturing Plant with wri+.ten verification that the facility qualif ies 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 Unpermitted <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 /> 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 /> V A WASTE TIRE STORAGE_STANDARDS V Ayy <br /> i <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b) Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§17353(a) Vector Cont:ros <br /> 0 (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 <br /> PRC§42850(a)-Complies with Terms of Permit r <br /> 0 0 0 14 CCR§17 354-Storage of YVaske o tres�7tatcloors ,W <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (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 /> Q (d)Drainage <br /> 0 0 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 /> 0 0 14 CCR§17351 -Fire Prevention Measures Q (h) Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 0 0 14 CCR§17356-indoor Storage <br /> 0 (b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> �e IA7s `lr,raye beer') f -,�nr��� ayco\ ck Ii <br /> ��{{ 0 d u C� CQCt`J OT C r _ <br /> _J_v_ y 1 I U o� Q OYI C n <br /> 1Jate (�e�ctto mctc� } e��sgn- ITS srGr �' yrs . <br /> o <br /> INSTRUCTIONS ON BACK ° .�,, .�, s { , , ��� 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />