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Waste Tire Arvey & Inspection R^rt I suRvf,rR Qu1al <br /> State of California f_ _ <br /> ClWMB 182 041041 Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Flirt C - Facility Information BLUE OR BLACK INK PEN <br /> Business Proflle - _ _ -,-Inspection Details _ — <br /> TPID- Inspection <br /> Suffix: 7 4`� <br /> Site f Report .. <br /> ` Number: I <br /> SWIS _ �.` / Inspection Q <br /> ection Number on the associated Survey form(Page 1) <br /> JNumber: Photos Taken <br /> Yes No <br /> Property Owner' -- — - — — - -— — -- — — — — — <br /> I Exempt Business Type (Fill if applicable) _ Permitted Regulatory Status (Fill one) <br /> I <br /> [Q PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption Q permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) _ _ � _ L <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded Q Unpermifted <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 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 /> J V A WASTIS TR STCF�AQE STAN_QAl3fJS _ V. A _ _._ <br /> . _ <br /> Permit Requirements Q Q 14 CCR§17352 Site Security <br /> Q Q PRC§42824--Maj or Waste Tire Facility Permit1 O (a)Signs O (b)Site Attendant O (c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit ' Q4Q 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 /> LQ I Q 14 CCR§17354-Storage of Waste Tires Outdoors_ <br /> Q Q : 14 CCR§18420(a)-Applicable for Permit I O (a)Storage Units <br /> Q Q 14 CCR§ 18423-Filing Application for Permit 0 (b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan <br /> O (c)Fire District Requirements <br /> Q Q 14 CCR§18433-Emergency Response Plan 0 (d) Drainage <br /> 0 (e)Slope/Grade <br /> ReCordkeeping Requirement _ _ I O (0 Siting(New Facilities) <br /> 0.Fro 14 CCR§18447-Records Available y O (g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> �Q (a)Communication Equipment O (c)Water Supply Q , Q , 14 CCR§17356-Indoor Storage ` <br /> 0 (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments /'� +�e�`7�{y ,J I IEif"5 �'✓PI L iv5t�7 ;, Ljl r' , l! c>C-.! <br /> �✓�d� ����-S /�1�--t�a'T�y ,�`t,`7(!�� '"C77^i`"K�7�^� -T'1"vt�' �a-�� <br /> ��� i✓�c �lr�5 �w�x-17 C�sf'�S �r I�� r�`� , <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: { V, E X R MP L E f 2 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />