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Waste Tire &-. vey & Inspection I rt SURVEY REQUIRED <br /> ■ ° : State of California ■ <br /> CIWMB 182 nage 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 /> - v -7 - 0 1 Inspection <br /> Site ffi - <br /> Site Suffix: 3 0 7 Report I �,JL 1 o <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes Q No <br /> Property Owner <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 exerription D Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 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 /> D 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises D Major WTF (>-5,000 Tires) <br /> 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 D Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V1 A I WASTE TIRE STORAGE STANDARDS V , A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> Q O PRC§42824-Major Waste Tire Facility Permit Q (a)Signs Q (b)Site Attendant Q (c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> C§42850Complies Terms of Pit Q (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> D PR (a)- ompes wPermit <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> D O 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> D O 14 CCR§18423-Filing Application for Permit Q (b)Fire Lanes <br /> D 0 14 CCR§18432-Operations Plan Q (c)Fire District Requirements <br /> D 0 14 CCR§18433-Emergency Response Plan Q (d)Drainage <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> D Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> O Q 14 CCR§17351-Fire Prevention Measures Q (h)Protection from Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment Q (c)Water Supply D 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> --- <br /> INSTRUCTIONS ON BACK Correct: Incorrect: ( (e XIA MJPJ LIEJ 1112 3 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />