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Waste Tire Arvey & Inspection Re,-,)rt s':1 <br /> State of California SURVEY.REQUIRED� <br /> ClWfAB 182(New 04M41 <br /> taManagi Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Fart C- Facility Information BLUE OR BLACK INK PEN <br /> (Business Profile — _ Ifnspection Details - -- <br /> TPID- Inspection <br /> Site Suffix: / <br /> 0 7 D t Report r Q" p, <br /> Number-. C/ [� <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - �� - l I Photos Taken Q Yes Q No <br /> Property Owner <br /> Exempt Business Type (Fill if applicable) — _ y _ Permitted Regulatory Status (Fill one) <br /> Q PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ? Excluded Q LJnpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast I 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 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 Q Minor WTF (500-4,999 Tires} <br /> Part D-Inspection of Waste Tire Facility <br /> /.-i�_... .....-- - _.....,..-...- ..... - - <br /> :..,A: <br /> t' Permit remenF�tAsa ^ Q 1-4 CCR——§1._735-2.-.Site <br /> .Security <br /> ecurity <br /> Q QI PRC§42824--MajorWaste Tire Facility Permit O (a)Signs O (b)Site At <br /> tendan,.t. O.�..�(c)Access ccess <br /> Q: Q PRC§42834-Minor Waste Tire Facility Permit oQ 14CCR§17353(a)-Vector-Control � <br /> � <br /> Q' QRC§42850(a)- es wPermit <br /> P2850Complies Terms of O (1)impermeable Barrier O (2)Approved Vector Plan— i <br /> Q Q 14 CCR_§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit ! O (a)Storage Units <br /> 0. Q 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes J <br /> Q' Q 14 CCR§18432-Operations Plan I O (c)Fire District Requirements <br /> 01 Q 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> Lf <br /> - y O (e)Slope/Grade <br /> Recordkee 'nRetuirement O (t)Siting(New F <br /> acilities) <br /> Q1-Q14 CCR§18447-Records Available ++ O (g)Rim Removal <br /> 14 CCR§17351-Fire Prevention Measures - - I + O (h)Protection from Pyrolytic Oil Runoff <br /> �O (a)Communication Equipment O (c)Water Supply Q , Q I 14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> -2W t'�r.•-5 �,-� rig P�G. t,�r- l bac' <br /> M <br /> _... ,.... 15386 <br /> INSTRUCTIONS ON BACK Correct: -_Incorrect: (� j X A Mil P f 2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />