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Waste Tireey & Inspection Re <br /> ■ '=kyr State of California ` SURVEY REQUIRED ■ <br /> CIWMB Integrated <br /> Waste <br /> eManag) Inspection Form - Page 2 - - - -- <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 3 S- 02 Report I <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken O Yes ® No <br /> Property Owner <br /> 0CC01 1 rvcK-17, TinGPot., �Aod_rk+o CA <br /> Exempt Business Type (Fill if applicable) IPermitted Regulatory Status (Fill one) <br /> O PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted O Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded O Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> O 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 dajs O Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STAND_ARDS ., V A <br /> Permit Requirements O O 14 CCR§17352-Site Security <br /> O 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 /> O O 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> O O 1 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement <br /> Q (f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available O (g)Rim Removal <br /> O O 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O (c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> 6130 t,szct 1 w u S k a-i r-c s CL A,-_WW OC tits i2c c+ C211`� . <br /> INSTRUCTIONS ON BACK Correct: JE XI A MJ P J �J E J 1 1 1 213 I 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />