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N Waste Tire S4&ey & Inspection Re -- - -Stat - - - <br /> CIW B California SURVEY REQUIRED ■ <br /> CI Integrated <br /> Waste <br /> Inspection Form - Page 2 <br /> California Integrated Waste Management Board --- - - — -------- <br /> Part C Facility Information BLUE OR BLACK INK PEN <br /> TPID- - <br /> Site Suffix: � Inspection <br /> Report <br /> [-TIA-1 <br /> – 7 -1 SWIS Number. <br /> r. <br /> �� Inspection Number on the asso7 <br /> ciated Survey <br /> Number f <br /> Photos Taken O Yes ONO <br /> Name h_o e Number Mailing Address rt <br /> y State ZIP_CO de <br /> �Q PRC §42823.5-Cement.Manufacturing Plant with written verification that the facility qualifies for exemption <br /> �r � Q rmitted Exempt <br /> 1Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ` <br /> Q Excluded Unpermltted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast rr r <br /> �Q 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises �� (moi _ , G <br /> i <br /> Q 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days O Major WTF (_>5,006 Tires) <br /> I� 14 CCR 18420 a <br /> §- O(7)& e Tire dealer storing no more than 1,5_00 waste tires_for 90 days 1 Q Minor WTF (500-4,999 Tires) i <br /> Inspection of Waste Tire Facility - - <br /> Part D - - — - -. <br /> V A WASTE TIRE STORAGE`STANDARDS_y „ '+ r'�A1r►iwX'+ fr <br /> AV <br /> . , . <br /> '�2yaT -U,Q PRC§O1 4284 Major Waste Tire Permit <br /> (a)Signs Q (b)Site Attendant Q (c)Access <br /> 01 Q PRC§42834-Minor Waste Tire Facility Permit <br /> Q O PRC§42850(a)-Complies with Terms of Permit (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> 1 Q 1 O 14 CCR§18420(a)-Applicable for Permit <br /> O (a)Storage Units <br /> 01 O 14-CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> Q1 14 CCR 18432- <br /> i 0 i § Operations Plan Q (c) Fire District Requirements <br /> Q O 14 CCR§18433-Emergency Response Plan 1 O (d) Drainage <br /> O e Slope/Grade <br /> l rr w • gg <br /> ::1 m�a1 P <br /> r" 0 (f)Siting(New Facilities) <br /> Q Q 14 CCR§ 18447-Records Available <br /> 0 (g)Rim Removal <br /> Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment Q (c)Water Supply _ t '� � � �,�, , <br /> (b)Fire Equipment erequrements I'� ATiOr Storage <br /> – Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> - L - <br /> - – – – – t <br /> — L4 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X ? t 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />