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■ ;_mm�!1". <br /> Waste of Tire S Vey & Inspection Rep SURVEY REQUIRED ■ <br /> ornInspection Form - Page <br /> t.'�� CIWMB 182(New 04/04) -- ---- --- _-- --- <br /> California Integrated Waste Management Board <br /> Part C FacHit Information BLUE OR BLACK INK PEN <br /> TPID- Inspection <br /> Site Suffix: rt <br /> Number: <br /> SWIS � - �- � Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken 0 Yes 0 No <br /> Property Ownef <br /> Phone Number Marling Address <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 applicable) <br /> 0 PRC §42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded 0 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 /> 14 CCR§18420 a 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 days - 0 Minor WTF (500-4,999 Tires) <br /> PPart D - Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> R 17352 <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b) Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§17353(a)-Vector Control <br /> 0 (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 0 PRC§42850(a) Complies with Terms of Permit 0 0 14CCR§'17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (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 /> Q (d)Drainage <br /> 0 0 14 CCR§18433-Emergency Response Plan <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement <br /> 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§ 18447-Records Available 0 (g)Rim Removal <br /> 0 0 14 CCR§17351 -Fire Prevention Measures O (h) Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 0 0 14 CCR§17356-Indoor Storage "ttrr17�477 7 , r '�, <br /> Q (b) Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> ,A <br /> .dor Iia SA rifle- <br /> J.q <br /> CCC y ffia,at S ;t,0 6 -/-p <br /> e 1&ic 1P DO < 3c <br /> _nA0 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X N,I E A Int I� 1 t 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />