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Waste Tire. Survey -& Inspection Report q s <br /> ■ °rs� SURVEY REQUIRED ■ <br /> �"Iti1.. Slats of CalNomla <br /> CIWMe,182(N. a11M) Inspection Form - Page 2 <br /> CalHomia lnteg MB 18 asle Management Board <br /> Part C-Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> sites ' 031$ q ( 5 O 1 Refection m _ I O <br /> Site Suffix: U ( I Y <br /> Number: <br /> SWIS ED �� Inspection Number on the associated Survey form(Page 1) <br /> Number: FU Photos Taken Q Yes ®No <br /> Property Owner <br /> L-Pd_goat 5350 ge1�c��� 4`7'708 <br /> Name P,,one Number WaiGngAdplress City Slate ZIP Code <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status(Fill one) <br /> Q PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies-for exemption Q Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) I*Excluded Q Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> Q 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 /> Q 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 S 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 Q Q 14 CCR§17352-Site Security <br /> Q Q PRC-§42824_-Major Waste Tire Facility Permit -O.(a)--Signs.• . -O-(b).Site_Attendant O_(c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q , 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> Q Q 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)Slope/Grade <br /> Recordkeeping Requirement <br /> O(1)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available O(g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment Q(c)Water Supply Q Q 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK Correet:� Incorrect: E X A m P L 1 2 3 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br /> ■ <br /> L <br />