Laserfiche WebLink
0 d,Waste Tire Survey & Inspection ReportState CIWM182(NewCalifomiIns ection Form - Pa e 2 <br /> CIWMB 102(New 04/04) p ('1ntegrated Waste Management Board `J' <br /> Part ililly Information _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection t� <br /> Site Suffix: , Z 2 - 0 , Report I - l t� 1 <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - - Photos Taken 0 Yes 0 No <br /> Property Owner <br /> FFxempt Business Type (Fill g applicable) Permkte d Regulatory Status(Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption Q Permitted ®Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded 0 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 W TF (?5,000 Tires) <br /> 0 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 10 14 CCR§18420 a 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 days 0 Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> Permit Requirements 0 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0(a)Signs O(b)Site Attendant O(c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 14 CCR§17353(a)-Vector Contral <br /> 0 0 PRC§42850(a)-Complies with Tema of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> 0 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit O(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 0 1 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)Slope/Grade <br /> Recordlteeping Requirement <br /> O(f}Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available ®(g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments 1, ^ lA (,Glt _CN <br /> < ' <br /> 6V-&&A- AA) 1 o�tk. CC.I'w� J P C.et3 AAA;� kA 0y'5 <br /> INSTRUCTIONS ON BACK � � E }( A P��r 2� 15386 <br /> ■ White Copy CIW MB -Yellow Copy:Operator Pink Copy.LFA ® ■ <br /> Pi5292015.005 <br />