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Waste Tire S,_.- vey & Inspection Rer -t SURVEY REQUIRED <br /> State of California <br /> CIWMedWasteManag) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> "n4Inspection Details <br /> TPID- Inspection <br /> Site Suffix: Z 1_' (!, 'f �� �' Report I — <br /> _ Number: <br /> SWIS m Inspection Numhei on the associated Survey form(Page 1) <br /> Number: I I - m- Photos Taken 0 Yes 0 No <br /> Pr <br /> IL it <br /> lie Phone Number Mailing Address City State ZIP Code <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Ex': Mi <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&used for bumpers or ballast <br /> t0 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 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 0 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days 0 Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V A Permit <br /> r TE TIRE t Requ emen sGE STANDARDS 0 0 14 CCR§17352,-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit �-0 0 <br /> (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit <br /> 0 0 14 CCR§ 18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 0 0 14 CCR§ 18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 0 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 NFPA 231D-1989 <br /> Comments 1 <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X __XTA MTP L 1 C 3 <br /> White Copy GWMg Yellow Copy:Operator Pink Copy:LEA <br />