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Waste Tire vey & Inspection Re, Tt SURVEY REQUIRED <br /> ■ <br /> .... <br /> i State of California <br /> E CIWMB182(New 04/04) Inspection Form - Page 2 --y- -- <br /> California Integrated Waste Management Board <br /> Part C- Facili Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- inspection <br /> Site Suffix: I 2 3 3 1 I Report I - O (J 8 2 2- <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - Photos Taken • Yes 0 No <br /> Property Owner <br /> Tom b4rvids - 2240 C0V,1J7P.,LJ Oil 8tIllt J''Alidda, Qs� <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 /> Part D- Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier O (2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 14 CCR§18420(a)-Applicable for Permit O (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 O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available O (g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolyuc Oil Runoff <br /> O (a)Communication Equipment O (c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> c� A nn � <br /> i c <br /> -- '�2�8g/ LwAerrvu� c.0 wao sr� ��� �,4 '/ � on e C. WA-A"I <br /> .oeAX a;igr <br /> :r1. - Aa- <br /> ;�9224 30 dAAs 73 Ae ��5 - <br /> nc.. - �a <br /> OF 77,1e- Cv16A V-'J,' — <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X E'X AFMA P I 2 3 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />