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Waste Tire SlOvey & Inspection Refit SURVEY REQUIRED <br /> State of California <br /> --ni <br /> ClWMB 4(New Mana 6 Inspection -Form - Page 2 <br /> California Integrated Waste Management Board � <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile nn�c+ nn ?? Inspection Details , <br /> - I -2 V U 6 O 4 U f Inspection <br /> TPID- <br /> Suffix: <br /> L(I <br /> - V ; <br /> � (_I Report <br /> Site Su <br /> __-�--- _' _ - _ �—•- Number: <br /> ' Inspection Number on the associated Survey form(Page 1) <br /> SWIS - <br /> Number: - ;_�— - I Photos Taken 0 Yes ® No <br /> Property Owner l <br /> MC Co TV4P_ &ry+Ce CQnkr 14W't551 , S H LAIV Qq 9D44DO 19 /5 <br /> Exempt Business Type. (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 1 <br /> Excluded Business Types(Fill if applicable) 0 Permitted Q ExempE <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water 8 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 <br /> 0 Major WTF (_0,000 Tires} <br /> 0 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 14 CCR 18420 a 7 8 e -Tire dealer storin no more than 1,500 waste tires for 90 da 0 Minor WTF (500 4,999 Tires} <br /> 0 § O(_) O 9 Ys <br /> i <br /> Part D- Inspection of Waste Tire Facility <br /> V 1 A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0 0 1 14 CCR§17352-Site Security f <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O(a)Signs O (b)Site Attendant O (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> 0 0 O(1)Impermeable Barrier O (2)Approved Vector Plan <br /> PRC§42850(a)-Complies with Terms of Permit <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 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available O (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 0 10 1 14 CCR§17356-Indoor Storage j <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments_tnVpice f:s V1 wed : -or was e- -fiyC. & &ic sal b� <br /> 1 f G�C(�tha . > i'IQ h CLu '�r �r�Ser t fi a-f- *m� t r nS(�tc7io n 'yrv- <br /> was a b1 J' � provide- hawser- recut'-�tlwi at Nv-re_s,0or&d 1 VeG� <br /> t <br /> 0-1i s -fo OteCcd 4" O( -00 4 0S , <br /> T <br /> I <br /> INSTRUCTIONS ON BACK I Correct: Incorrect: ]{ g EIx AIMS p 2 3 I 15386 <br /> White Copy:CIW MB Yellow. Copy:Operator Pink Copy:LEA <br /> . I <br />