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'ata:6 of-California California Integrated Waste <br /> CIWMB 503 (Rev. 9/02) Management Board <br /> WASTE TIRE FACILITY <br /> EMERGENCY RESPONSE PLAN <br /> I. GENERAL INFORMATION(please print or type) SWIS#: <br /> Facility Name: <br /> Facility Mailing Address: <br /> City: County: State: Zip: Phone: <br /> Facility Operator's Name: <br /> Mailing Address: <br /> City; County: State: Zip: Phone: <br /> Property Owner's Name(if different from operator): <br /> Mailing Address: <br /> City; County: State: Zip: Phone: <br /> II. EMERGENCY CONTACT LIST <br /> List the names and telephone numbers of the persons and appropriate agencies to be contacted in case of emergency: <br /> Name Phone <br /> Facility Owner: <br /> Facility Operator: <br /> Local Fire Authority: <br /> Local Environmental Health Dept: <br /> Regional Water Quality Control Board: <br /> Any additional numbers that may be needed: <br /> III. EQUIPMENT <br /> Emergency Response Equipment Available: <br /> ❑ 1. Minimum equipment required: <br /> ❑ One,dry chemical fire extinguisher Weight: <br /> ❑ One,2'/:gallon water extinguisher <br /> ❑ One, pike pole at least 10 feet in length <br /> ❑ One round point and one square point shovel <br /> OR <br /> ❑ 2. Equipment in lieu of the list above(attach fire authority approved requirements): <br />