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Waste Tire 31 ey & Inspection Re. t SURVEY REQUIRED <br /> •..�,�• State of California <br /> CIWMedWast(New Mana a Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facilit Information BLUE OR BLACK INK PEN <br /> B17 <br /> usiness Profile — Inspection Details <br /> TPID- Inspection I _I <br /> Site Suffix: I l 1 3 5 ' 2- q S 6 ' Report <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: I' Photos Taken o Yes ®No <br /> __MSC Tt uLk _T e- Wit- . _ 1L 1 q01 Lang PcA rn AYe oAvio C' 95-Sl <br /> P7tone umber Mailing Address Lily State ZIP Code <br /> Exempt Busineall IF 111 11 <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 permitted 0 Exempt <br /> Excl <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) (0 Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast <br /> 0 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 WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0,' 4 CCR§17352-Site Security <br /> o 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 <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit (1)Impermeable Barrier (2)Approved Vector Plan <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 Q (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 CCR§17356-In <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> IF—CIT wtnn�C <br /> es' s ,nage been re.�ra�yw_d �,►�eYe ta_�c�_LL�� Jo- dor <br /> `+,ems , fear 1--t-Q a S-+- �CacIIdill r` ru-�'eS A6 0a13 .wt r.o (,PgI_1-tered vim: <br /> V.Q_n l LaZ -TUa&] N16nIC 1e- 6 C _ �De.c.ccx\ "r <br /> uixv'A v500 HD -7 Z_-LI-1 2- oR- ooh a 2 <br /> Veh\CI. _.r.o4ck\m c.,_Arrrtn-� (C��i W MFS_ �rG�'ton C e-y-+J,C,gr-P__ <br /> N1 ( �1►01 A�I o n,, Or (�C eQ s_ 4t' C.C)r , , . . 4r& <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X �j I E XI A MI P, L I EJ 1112131 15386 <br /> White Copy:CIWMB Yellow Copy Operator Pink Copy:LEA I <br />