Laserfiche WebLink
—T <br /> Waste Tire SAey & Inspection Rep I SURVEY REQUIRED <br /> Slate of California ` <br /> CIwMedWast(New Manage Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information 1 BLUE OR BLACK INK PEN <br /> Business ProfileCSI - Inspection Details <br /> TPID- - ---- k� `f Inspection <br /> Site Suffix: / I '_ I iO: 7 12 "O Report <br /> L _.1_ ' - -- : 1 �_ ._ umer. <br /> ), NbL— ��— - - — ---- <br /> SWIS � r--- Inspection Number on the associated Survey form(Page 1) <br /> Number: f ' `-- _ Photos Taken ® Yes 0 No <br /> Property Owner <br /> ` e- _ 33 103 � ,�-3 AW 710" - <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> 0 PRC §42823.5-Cement Manufacturing Plant with wri4n 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 to 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 /> 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 ¢!,j <br /> VI A I WASTE TIRE STORAGE STANDARDS V ' A <br /> Permit Requirements ® 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit ® (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> ® 0 PRC§42834-Minor Waste Tire Facility Permit ® 0 14 CCR§17353(a)-Vector Control <br /> 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit ® 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 (d)Drainage <br /> 0 0 14 CCR§18433-Emergency Response Plan 0 (e)Slope/Grade <br /> Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> (a 0 14 CCR§17351 -Fire Prevention Measures" 00 (h)Protection from Pyrolytic Oil Runoff <br /> 0(a)Communication Equipment 0 (c)Water Supply 010 1 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compiiance with NFPA 231 D-1989 <br /> Comments 'f'ft 0 0 <br /> —_ ja-rne. AIye�.re i✓ a—�P _Ci bye vro(t:�,fr o n s yw N V <br /> ro S-�o�' •e- i Sue S o *eS Oca�Oh L!u l V't 10��m i f• / I/i o-- <br /> 1� nge wtp- now Md d�scussQd wig. aoerafor. MLzf- <br /> j �p/ f l OvV- and Wrr# amu 10/a.r' - r _ a ltl6zo 6 <br /> aw► tr�i'f Gl 00jhty- Q�Aj of <br /> V;QIO'bi0#1 _3 f ii ue e - 7�I,D /od I q9V `D f <br /> irrl ager Ct0uk W7 le"lefion ct nd f arra �uQ nat'Pc� `res <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: L E .- 11_12 <br /> White Copy.CIW MB Yellow Copy:Operator Pink Copy:LEA <br />