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Waste Tire . $@rvey & ..Inspection Rel rt SURVEY REQUIRED <br /> r�C117:w State of California I <br /> CIWMedWasteManag) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- I ----' p� Inspection --T <br /> Site Suffix: 1111,31311 I I l.J NReport <br /> umber: I O 12? <br /> SWISn Inspection Number on the associated Survey form(Page 1) <br /> Number: 1E <br /> I - EE1- <br /> ELLL <br /> Photos Taken 0 Yes 0 No <br /> Property Owner <br /> � <br /> !Marne Nnu,7e Numhar i1,aj.t,r).4 dress Ci 51a,e 71,06Code <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory.Status (Fill one) <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applioable) a <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded ® 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 ® Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O (a) Signs Q(b)Site Attendant Q (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit .0 0 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> 0 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan Q (d)Drainage <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement <br /> Q (f)Siting(New Facilities) <br /> q0 0 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 0 0 14 CCR§17351 -Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> Q(a)Communication Equipment Q (c)Water Supply 0 0 .14 CCR§17356-Indoor Storage <br /> Q(b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK "dffiro.111�' Incorrect: EI}( µ P 315386 <br /> White CYellow Copy:Operator Pink Copy:LEA <br />