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Wastea ,r Tire %vey & Inspection Rt., -rt SURVEY REQUIRED <br /> ■ ilii <br /> CIWMB182(New <br /> 04/04) Inspection Form - Page 2 <br /> Callfomia Integrated Waste Management Board <br /> Part C- Facility Information _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- `7 Inspection D <br /> Site Suffix: Report I <br /> S � 0 <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - Photos Taken Q Yes Q No <br /> Property Owner <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> Q PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption Q Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded Q Unpermitted <br /> ® 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> Q 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises Q Major WTF (_>5,000 Tires) <br /> Q 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 ® Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS —V i A <br /> Permit Requirements Q 014 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> Q (1)Impermeable Barrier O (2)Approved Vector Plan <br /> Q Q PRC§42850(a) Complies with Terms of Permit Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> Q Q 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available O (g)Rim Removal <br /> Q Q 1 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment O (c)Water Supply Q 0 14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA231D-1989 <br /> Comments <br /> R U fel CY�Q.f 1 5 �O r f <br /> -i— 15386 <br /> INSTRUCTIONS ON BACK : Correct: Incorrect: (�" �/ _ 7( A P (- 2 <br /> ■ White Copy:COMB Yellow Copy:Operator Pink'Copy.LEA ® ■ <br />