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= Waste Tire <br /> -ii�_• � ev & Inspection R <br /> State of California EsURVEII'RE qU <br /> IRED <br /> 182 <br /> Page 2 <br /> CWMB mentBoard Inspection Form - <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - �A I 1 _ l Inspection <br /> Site _ 1 O <br /> Site Suffix: "� I Report I <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 /> 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 /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded Q Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> O 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 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 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 O O 14 CCR§17352-Site Security <br /> O O PRC§42824-Major Waste Tire Facility Permit Q (a)Signs Q (b)Site Attendant Q (c)Access <br /> O O 14 CCR§17353(a)-Vector Control <br /> 40 Q PRC§42834-Minor Waste Tire Facility Permit <br /> Q (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> O O PRC§42850(a)-Complies with Terms of Permit O O 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 /> Q 014 CCR§18432-Operations Plan <br /> Q (d)Drainage <br /> O 0 14 CCR§18433-Emergency Response Plan Q (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> O Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 00 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment Q (c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK Correct:__Incorrect: ( f E X A p! �i 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />