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Waste Oreft'Svey & Inspectia mrot SURVEY REQUIRED <br />im <br />State of California <br />COMB 182 (New 04104) Inspection Form - Page <br />California Integrated Waste Management Board <br />M a ars nR RI 4f:K INK PEN <br />Part G - I-acliny Information <br />Inspection Details <br />- - <br />Business Profile <br />TPID - <br />Site Suffix: 4- <br />r;,, L 'LI -1 `� U � <br />Inspection <br />Report I <br />— �` <br />i e t <br />Number: <br />Inspection Number on the associated Survey form (Page 1) <br />SWIS <br />Number: <br />Photos Taken 0 Yes <br />0 No <br />Property Owner <br />Q (a) Signs Q (b) Site Attendant Q (c) Access <br />.Exempt Business Type (Fill if applicable) <br />Permitted Regulatory Status (Fill one) <br />0 PRC § 42823.5 - Cement Manufacturing Plant with written verification that the facility qualifies for exemption <br />0 Permitted 0 Exempt <br />0 Excluded 0 Unpermitted <br />Excluded Business Types (Fill if applicable) <br />0 <br />0 PRC § 42808 - Permitted Solid Waste Facility (Landfill, Transfer Station) <br />Facility Type (Fill one) <br />0 14 CCR § 18420 (a) (2) - Agricultural < 5,000 tires incapable of holding water & used for bumpers or ballast <br />Recordkeeping Requirement <br />0 <br />0 14 CCR § 18420 (a) (4) - Tire retreading facility with no more than 3,000 waste tires on premises <br />14 CCR § 18447 - Records Available <br />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 />14 CCR § 17351 - Fire Prevention Measures <br />Q (a) Communication Equipment Q (c) Water Supply <br />Q (b) Fire Equipment Q (d) Other Requirements <br />00 <br />0 Minor WTF (500 - 4,999 Tires) <br />14 CCR § 18420 a) (7) & e) -Tire dealer storing no more than 1,500 waste tires for 90 days <br />Facility Compliance with NFPA 231 D-1989 <br />1-01 <br />V j A WASTE TIRE STORAGE STANDARDS _ <br />V <br />A <br />_ <br />Permit Requirements <br />0 <br />0 <br />14 CCR § 17352 - Site Security <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />PRC § 42824 - Major Waste Tire Facility Permit <br />PRC § 42834 -Minor Waste Tire Facility Permit <br />PRC § 42850(a) -Complies with Terms of Permit <br />14 CCR § 18420(a) - Applicable for Permit <br />14 CCR § 18423 - Filing Application for Permit <br />14 CCR § 18432 -Operations Plan <br />14 CCR § 18433 - Emergency Response Plan <br />Q (a) Signs Q (b) Site Attendant Q (c) Access <br />00 <br />14 CCR § 17353(a) - Vector Control <br />Q (1) Impermeable Barrier Q (2) Approved Vector Plan <br />0 <br />0 <br />14 CCR § 17354 - Storage of Waste Tires Outdoors <br />Q (a) Storage Units <br />Q (b) Fire Lanes <br />Q (c) Fire District Requirements <br />Q (d) Drainage <br />Q (e) Slope/Grade <br />Q (f) Siting (New Facilities) <br />O (g) Rim Removal <br />O (h) Protection from Pyrolytic Oil Runoff <br />Recordkeeping Requirement <br />0 <br />0 <br />14 CCR § 18447 - Records Available <br />0 <br />0 <br />14 CCR § 17351 - Fire Prevention Measures <br />Q (a) Communication Equipment Q (c) Water Supply <br />Q (b) Fire Equipment Q (d) Other Requirements <br />00 <br />14 CCR § 17356 - Indoor Storage <br />Facility Compliance with NFPA 231 D-1989 <br />Comments <br />oe— <br />/ 1 b3t5b <br />INSTRUCTIONS ONBACK Correct:incorrect:'I�(Ak� k I P f <br />l 2—U3 <br />® White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA ® 0 <br />