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r <br /> Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> _; :• State Inspection Form - Page 2 <br /> State o Cal iNew 0004) P <br /> California integrated Waste Management Board f BLUE OR BLACK INK PEN <br /> Part C-Faci!LtyInformation <br /> Inspection Details <br /> 9usiness Profile <br /> / l 2 Inspection XA <br /> TPID- I `( J S 0 1 • [Report I - , O J 5 V <br /> Site Suffx: Number. <br /> inspection Number on the associated Survey form(Page 1) <br /> SWIS <br /> Number: - Photos Taken 0 Yes 0 No <br /> Property Owner <br /> j-"V-SBafnLam Plod i Aje MoAsib CA <br /> � <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 0 Permitted 0 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 WTF (>_5,000 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 /> 0 Minor WTF (500-4,999 Tires) <br /> in 14 CCR§18420(a)7) a)-Tire dealer storing no more than 1,500 waste tires for 90 days <br /> Part D­Inspection of Waste Tire Facility <br /> V I A WASTE TIRE STORAGE STANDARDS IVI EAPermit Requirements 52-Site Security <br /> 0 0 PRC§42824-Major Waste T'Ire Facility Permit ns (b)Site Attendant (c)AoCess <br /> 00 53(a)-Vector Control <br /> PRC§42834-Minor Waste Tire Facility Permitermeable Barrier O(2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(s)-Applicable for Permit O(a)Storage Units <br /> 0 0O(b)Fire Lanes <br /> 14 CCR§18423-Filing Application for Permit <br /> O(c)Fire District Requirements <br /> 0 0 14 CCR§18432-Operations Plan O(d)Drainage <br /> 0 0 14 CCR§18433-Emergency Response Plan 0(a)Slope/Grade <br /> Recordkeeping Requirement 0(f)Siting(New Facilities) <br /> 00(a) <br /> 14 CCR§18447-Records Available O(9)Rim Removal <br /> O(h)Protection from Pyrolytic Oil Runoff <br /> 14 CCR§17351-Fire Prevention Measures <br /> Communication Equipment Q(c)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> Fire Equipment O(d)Other Requirements /,�,,� Fac HityCompliancewith N,F�PAA231D-1989 } <br /> Comments T rnQi'�t S r�y�,cweot.. G iey-a*y- �Fl�r_,'4h0n-0Y1 <br /> iW �DTS tiaye- been recon d as ame as Aau-jer" 4�/loasie <br /> 'S r' GuSs�Y)ot + on Sired 1 �Yotm MC�Y <br /> U,Jey- oto <br /> a_ 'r�OY✓!.( ' /G0. D� ri� .?.I�Sur'e{ "fha.�' Or+ 4✓ _���D C� <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: (� E X AIM P L E ) Z 3 ® ■ <br /> ■ White Gogy GIVJfdB Yellow copy.operator Pink Copy LEA <br />