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Waste Tire Sevey & Inspection Repta <br /> (E� , <br /> StateotCalifornia <br /> CIWMB182(Now 04104jIns' action Form - Page 1:_ ��"G• '��: <br /> California Integrated Waste Management Board p g <br /> Part C -Facility_Information._.._.. _— ____ BLUE OR BLACK INK-PEN <br /> Business Profile Inspection Detalls <br /> TPID- Inspection <br /> Site Suffix: t 3 5-4 6 f7 ' Report <br /> Number: t <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 exemption Q Permitted Q Exempt <br /> Excluded Business Types{Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q 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 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> .Q 14 CCR 118420_(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days Q Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility _ <br /> �y :> '; l' y ✓ l/ /v �TS:r /y,.r, M �/ <br /> Permit Requirements Q Q 14 CCR§173 2-Slte Security <br /> -- I - <br /> Q Q § J Y _ s O (b)Site Attendant O (c)Access <br /> Q Q - § - - - <br /> PRC 42824-Major Waste Tire Facility Permit O (a)Sign <br /> Q ® PRC§42834-Minor Waste Tire Factlity Permit _ 14 CCR 17353{a)-Vector Control — — <br /> Q Q Q (1)Impermeable Barrier O (2)Approved Vector Plan <br /> PRC§42850(a)-Complies with Terms of Permit - - - -- - - --- "- -- <br /> Q Q 14 CCR§17354.Storage of Waste Tires Outdoors <br /> Q Q ! 14 CCR§18420(a)-Applicable for Permit Q (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 /> O (d)Drainage <br /> Q Q 14 CCR§ 18433-Emergency Response Plan <br /> _._ --__ _-.. O (e)Slope/Grade <br /> Recordkeepin� Requirement O (f)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 O (c)Water Supply 0101 14 CCR§17398-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comm' <br /> > <br /> v1_ P> <br /> Y�-C L C�P'� `D <br /> _ -- - - <br /> ----------. ---- <br /> t-A-Ir-L <br /> -cA,Ir-L y IDv_ <br /> "1'D'- - +M k ski d�•t 5 1�,,� "� ( -o s <br /> f C 15386 <br /> INSTRUCTIONS ON BACK AW P w� <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />