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E _ Waste Tire St.. vey & Inspection Rep..rt SURVEY REQUIRED <br /> ■;i : State of California <br /> CIWMB WasteManagementInspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> - - Part-C --Facility-Information BL-UE-OR-BLACK-INK-PEN -- <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: I U 8 - 8 0 Report I I — 7 -7 b 3 3 <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 O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded Q Unpermitted <br /> Q 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 O 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 /> V1 A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements . Q Q 14 CCR§17352-Site Security <br /> Q O PRC§42824-Major Waste Tire Facility Permit O (a)Signs O(b)Site Attendant O (c)Access <br /> O O PRC§42834-Minor Waste Tire Facility Permit O O 14 CCR§17353(a)-Vector Control <br /> O O PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier O (2)Approved Vector Plan <br /> Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 14 CCR§18432-Operations Plan <br /> (c)Fire District Requirements <br /> O O 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement <br /> 0 (f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available Q (g)Rim Removal <br /> O 0 1 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment Q (c)Water Supply Q 14 CCR§17356-Indoor Storage <br /> (b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK Correct: Incorrect: F A Ml P E� 11 T�3 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />