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Waste Tire S,.-_ ✓ey & Inspection Rer- tSURVEY REQUIRED <br /> Stateof California <br /> CIWMB182(New04/04) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C- FacilityInformation BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> 1Inspection <br /> TPID- l O� � � J � - � � Report I - <br /> Site Suffix: b Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> SWIS <br /> Number: Photos Taken Q Yes ® No <br /> Property Owner <br /> L1-.C., a(Fl-qq,�>,5e 50E. rno0 <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> O PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q 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 /> 0 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises O Major WTF (_>5,000 Tires) <br /> O 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 40 Minor WTF (500-4,999 Tires) <br /> 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1 500 waste tires for 90 days <br /> Part D- Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> Q (a)Signs Q (b)Site Attendant Q (c)Access <br /> Q 0 PRC§42824-Major Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> ® O <br /> PRC§42834-Minor Waste Tire Facility Permit roved Vector Plan <br /> Q (1)Impermeable Barrier Q (2)App <br /> O O PRC§42850(a)-Complies with Terms of Permit O Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit Q (b)Fire Lanes <br /> Q (c)Fire District Requirements <br /> O O 14 CCR§18432-Operations Plan <br /> Q (d)Drainage <br /> O O 14 CCR§18433-Emergency Response Plan Q (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available Q (g)Rim Removal <br /> Q (h)Protection from Pyrolytic Oil Runoff <br /> 00 <br /> 14 CCR§17351 -Fire Prevention Measures <br /> Q (a)Communication Equipment Q (c)Water Supply O Q 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> SC 'C� <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: ( \/) qPi, <br /> Ip; I 1 <br /> White Copy:CIW MB Yellow Copy:Operator Co . <br />