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>a3� Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> ➢➢➢"- State of California <br /> CIWatedWa eMang6 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 --i �- i - Inspection <br /> Site Suffix: I `y, i (J 15 i - ;p ( Re ort <br /> P Il - I <br /> - __ _ Number: f. ! w -� -� <br /> SWIS ; I I 1 i I i Inspection Number on the associated Survey form(Page 1) <br /> Number: _I__I - L _ - _� �__i J Photos Taken 0 Yes Q No <br /> Property Owner <br /> Alco-ZTan ".Me�ci1 -W -- d1:97g3R_C[sto CIa•OL, CZ._ wc����. bt, oEoc,K� c0. <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 O Permitted 0 Exempt <br /> Excluded.Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q Excluded 0 Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> O 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises Q Major WTF (>5,000 Tires) <br /> O 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 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 /> O O PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 PRC§42834-Minor Waste Tire Facility Permit O O 14 CCR§17353(a)-Vector Control <br /> O Q PRC§42850(a)-Complies with Terms of Permit 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O Q 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> O Q 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 O 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> Q O 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> - Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> Q O 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0! O 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0(c)Water Supply Q o 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> &eIle, cc me fs <br /> INSTRUCTIONS ON BACK Ah Correct: Incorrect: E X A P L Z Z 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator- Pink Copy.LEA <br />