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i City/county Waste 'Y ire Survey and Inspection Repo. Mailing Address "- Phone Number I State of California CIWMB-54(10/03) PART A—General Information/Survey Page of BONN I 'MaiWspECilO fS1TE�, !§ff Type(Check one): E3-Routine ❑Re-inspection ❑Complaint ❑ Observation ❑CIWMB Referral ❑CHP Referral ❑ Other. Facility SWIS: - Anspecte by Time In: Dat Regulatory Status File No = TPID: QDa h u /City 4 ) p ❑ Permitted Excluded Exempt❑Unpermitted i. Laky e Time Out: Total ime: :Operational Status Hauler!D- Local: ++� ' ❑State Local: 1 +e Q Closed inactive El Planned Business/Facility Name: Tire Count: Type: r• B-Passenger[]Altered❑Truck❑ OTR AVA t Phone: =Storage Type'c ss s: �s i rt Addres �� 2765 7 g`� U� v.� �❑Outdoor l�dooc❑Conamer,, _: O ner: Infector(Please Print): Business Rep Title: ;h&.ck s)Facility.Type" one Role'of_Businesss"(ChsckauthotipPt9)'3 FlMajor WTF(>5.0cc^•es) ❑ Minor WTF(>soo fires) E3-1Naste Tire Location (<soo tires) Generator ❑ Hauler ❑ End-use Business Type:(check an not apply) ®Tire Dealer ❑Retreader ❑Dismantler ❑Auto Repair ❑Auto Body []Car Dealer ❑Collection ❑Gas Station ❑Trucking Fleet ❑Shredder ❑Crumb Rubber ❑ Other:Describe - .� a Excluded Business Types(check only 1f Applicable): ' ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(Waste Tire Location). —0--14 CCR§ 18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises. ❑ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. �_14 CCR§ 18420(a)(7)8(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from permit,ccr*oiete Paas B and D. M not excluded from permit requirements complete Parts B,C.and 0. PART B—Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility _Z---r t HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. ❑ p ❑ 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. ❑ ❑ ❑ 14 CCR§18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. K❑ ❑ E] 14 CCR§18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ [1 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ ❑ 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C—Inspection of Waste Tire Facility Tk 'k�� r� -Ptarmits Requirenient ,�.i�r`<2. "�u '�" a-�'s.' �=[*1`�["�" �❑°f'°' �14�CCR§:1735?.,"-SSite.S _ x ❑ ❑ ❑' PRC§42824-Major Waste Tire Facility Permit ❑(a)Signs El (b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit [ C] ❑ PRC§42850(a)-Complies with Terms of Permit §`17353iaeoCoirol' ❑ ❑ ❑ 14 CCR§18420(a) -Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan 01 ❑ 01 14 CCR§18423 -Filing Application for Permitz[ [ C14tCCR.§17354toragier�of,Waste;Tires Outdoors; *' Recofdkteping 1116 uTerrients ❑(a)Storage Units ❑ (b)Fire Lanes ❑ ❑ C] 14 CCR§18432-Operations Plan ❑ (c)Fire District Requirements E] ❑ ❑ 14 CCR§18433-Emergency Response Plan ❑ (d)Drainage C] ❑ E] 14 CCR§18447-Records Available El ( Slope ❑ (ff)) (Grade Siting(New Facilities) 14 CCR 17351,=Fire Prevention Measures `` ❑ (g)Rim Removal ❑(a)Communication Equipment ❑ (h)Protection from Pyrolytic Oil Runoff ❑(b)Fire Equipment [ [ [' '14 CCR§17356`-Indoor Storage ❑(c)Water Supply ❑(d)Other Requirements Facility compliance with NFPA 231 D1989