Laserfiche WebLink
"" Waste Tire SOnspey & Inspection Rei 't <br /> SURVEY REQUIRED <br /> -i75� State of California <br /> f CIWM8182(New 04r04) ection Form - Page 4 - - - <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> I$usin Inspection Details <br /> TPID- Inspection <br /> Site Suffix: ! I ' � � ,: J - " Report <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m Photos Taken O Yes O No <br /> Property Ow <br /> Phone Number Mailing Address City State ZIP Code <br /> Exempt Business Type (Fitt <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted 0 Exempt <br /> EXClud&Jhj1,W2 ,JWes(Fill-if a p' <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded 0 Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast <br /> (� 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 /> 14 CCR§18420 a 7 & e Tire dealer storing no more than 1,500 waste tires for 90 days O Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 14 CCR§17352-Site Security <br /> O O PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> O O PRC§42834-Minor Waste Tire Facility Permit <br /> O O PRC§42850(a)-Complies with Terms of Permit 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> Outdoo <br /> O O 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan 0 (c) Fire District Requirements <br /> O Q 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply ` <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NF1)-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK Correct: Incorrect: X iX,A M1 P I L I El 1f 2 3 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA Ns� <br />