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JWaste Tire Survey & Inspection Report <br />state of California <br />CIWMa,62(NewC I Inspection Form - Page 2 <br />California lrft raNd Waate blanagew*nt Board <br />Part C - Facility Information <br />Business Profile - - — <br />TPIO - <br />Site Suffix: <br />SWIS <br />Number: ' <br />Property Owner <br />ti ea*�r]10 _ _ _i <br />BLUE OR BLACK INK PEN <br />Inspection De ails <br />— — — Inspection <br />Report I <br />Number: C <br />Inspection Number on the associated Survey form (Page 1) <br />Photos Taken Q Yes Q No <br />Exempt Business Type (Fill if applicable) . L Permitted Regulatory Status (Fill one) <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) <br />Q PRC § 42808 - Permitted Solld Waste Facility (Landfill, Transfer Station) Q Excluded 48 Unpermitted <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 />Q 14 CCR § 18420 (a) (7) & (e) -Tire dealer storing no more than 1,500 waste tires for 90 days 4b Minor WTF (500 - 4,999 Tires) <br />Part D - Inspection of Waste Tire Facility <br />Permit Requirements <br />I Q <br />I Q <br />14 CCI# § 17352 - Site Security <br />Q <br />0, PRC § 42824 - Major Waste Tire Facility Permit <br />_ <br />0(.)Signs O (b) Site Attendant O (c) Access <br />Q` <br />Q <br />PRC § 42834 - Minor Waste Tire Facility Permit <br />I_ <br />0 <br />14 CCF) § 17353(a) - Vector Control <br />Q <br />Q <br />PRC § 42850(a) - Complies with Terms of Permit <br />go <br />O {1) Impermeable Barrier O (2) Approved Vector Plan <br />14 CCR 117354 - Storage of Waste Tires_ Outdoors <br />Q <br />0, <br />14 CCR § 18420(a) - Applicable for Permit <br />O (a) Storage Units <br />Q <br />Q <br />14 CCR § 18423 - Filing Application for Permit <br />O (b) Fire Lanes <br />Q O <br />14 CCR § 18432 - Operations Pian <br />O (c) Fire Distriot Requirements <br />Q Q <br />14 CCR § 18433. Emergency Response Plan <br />O (d) Drainage <br />O (e) Slope/Grade <br />RecordkeepingRequirement_ <br />O (f) Siting (New Facilities) <br />Q <br />Q <br />14 CCR § 1B447 - Records Available <br />O (g) Rim Removal <br />0 <br />Q <br />14 CCR § 17351- Fire Prevention MeasuresO <br />(h) Protection from Pyrolytic Oil Runoff <br />O (a) Communication Equipment O (c) Water Supply <br />Q Q_J <br />14 CCR 117356 Indoor Storage <br />O (b) Fire Equipment O (d) Other Requirements <br />_ __- <br />Facility Compiance with NFPA _ 231D-1989 <br />Comments "`t 14,10"VI..g 71MCAIV-r—�k, <br />'OT <br />11) k7-55k'�,r-t'�rwc�t�Ea1vC <br />� t t S <br />2)-T%} ex -k �7 31�t �—e`�Co(v�t�'rr�� <br />1 -�— <br />1 �'tCC� �735-i �-i�Ott-ao t a VvA--S' \t Vr-JV <br />wtk ►) , 2�D Aagr S <br />1 r <br />!'\,Kr <br />oca"� 14 Y e"41%4�vl wt -S,o ay., <br />awkklta r% zlelC - <br />7 <br />15366 <br />. INSTRUCTIONS ON BACK <br />CO <br />) A N, p L1112131 <br />White Copy: CIWMB Yellow Copy. Operator Pink Copy: LEA ® ■ <br />06-17105.121009 <br />