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Waste Tire SAey & Inspection Rept SURVEY REQUIRED <br />:.. State of California ■ <br />CIWMB 182 (New 04/04) Inspection Form -Page 2 - -- ------------ <br />California Integrated Waste Management Board <br />Part C - Facility Information BLUE OR BLACK INK PEN <br />TPID - <br />Site Suffix: <br />SWIS <br />Number: <br />L.—... .---,.___.. <br />Na/ne <br />1 ( ����;��I� Inspection f <br />✓ \ \ C 1 Report — ; t <br />Number: _.? _ <br />Inspection Number on the associated Survey form (Page 1) <br />Photos Taken 0 Yes O No <br />O PRC § 42823.5 Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted Q Exempt <br />O PRC § 42808 - Permitted Solid Waste Facility (Landfill, Transfer Station) 1 O Excluded 0 Unpermitted <br />O 14 CCR § 18420 (a) (2) - Agricultural < 5,000 tires incapable of holding water & used for bumpers or ballast rQiNiF <br />a <br />i <br />I MON� a.._ 1, w< <br />0 14 CCR § 18420 (a) (4) - Tire retreading facility with no more than 3,000 waste tires on premises O Major WTF (> 5,000 Tires) <br />Q 14 CC R § 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 <br />Q Minor WTF (500 - 4,999 Tires) <br />Part D - Inspection of Waste Tire Facility <br />V A WASTE TIRE STORAGE STANDARDS <br />V <br />A <br />i ,r ^; r ,. ,✓ .% r✓ r e �' p 7,pf, <br />rt 11� "r f <br />1905",01,"q�„ k Y <br />v r „i,,: „ir 't{ w ; } w i 1 m w; m ,rr �r r!, <br />' �",*,;"�' " ? A r� dSti ., Y� �p n <br />Q <br />0 <br />V IN <br />PRC § 42824 - Major Waste Tire Facility Permit <br />2 <br />,TA"Gi,:: <br />0 (a) Signs 0 (b) Site Attendant 0 (c) Access I <br />P r�(1� t xv"a t r <br />Q <br />Q <br />PRC § 42834 -Minor Waste Tire Facility Permit <br />fr <br />tu���r „� y r <br />�:.: �ta�a,f� �d��,»,r�„'.�.t:” <br />.. <br />0 (1) Impermeable Barrier 0 (2) Approved Vector Plan <br />PRC § 42850(a) - Complies with Terms of Permit <br />t ti <br />p <br />All <br />O <br />O 14 CCR § 18420(a) - Applicable for Permit <br />0 (a) Storage Units <br />O <br />O 14 CCR § 18423 - Filing Application for Permit <br />0 (b) Fire Lanes <br />O <br />O 14 CCR § 18432 - Operations Plan <br />0 (c) Fire District Requirements <br />0 (d) Drainage <br />O <br />O 14 CCR § 18433 - Emergency Response Plan <br />0 SI /Grade <br />O I O 114 CCR § 18447 - Records Available <br />0 (a) Communication Equipment 0 (c) Water Supply <br />0 (b) Fire Equipment 0 (d) Other Requirements <br />0 (f) Siting (New Facilities) <br />0-(g) Rim Removal <br />0 (h) Protection from Pyrolytic Oil Runoff <br />Facility Compliance with NFPA 231 D-1989 <br />15386 <br />INSTRUCTIONS ON BACK f Correct: Incorrect: X r� '', e }; A P o � e! 1112 3 <br />■ White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA ■ <br />