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., Waste Tire Mey & Inspection Reat SURVEY REQUIRED <br /> +i State of California <br /> tested Waste <br /> 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- Inspection <br /> Site Suffix: 3S <br /> J L 1 ReportI t 1 1 <br /> l Number: l l <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - Photos Taken *Yes 0 No <br /> Property Owner -T-re 4/e �j _�/J o <br /> 4es <br /> L4Z <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 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 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 0 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 I A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0 0 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 0 0 14 CCR§17353(a)-Vector Control <br /> Q (1) Impermeable Barrier O (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 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 /> 0 (d)Drainage <br /> 0 0 14 CCR§18433-Emergency Response Plan <br /> _ 0 (e)Slope/Grade <br /> Recordkeeping Requirement 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 (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment 0 (C)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: X ',� � 7 A MT <br /> I� 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />