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08066030001 <br /> Waste Tire Survey & Inspection Report sURUEYREEMIREN <br /> iPiu Stele of Calitomla � <br /> ClwMe182(Ne*04104) Inspection Form - Page 2 <br /> Calffornla Integratetl WastemManagement aoaN <br /> Part C-Facility Inforation BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: t/I I (0 l j} I -1 0 ' Number: I I 01 `��7 <br /> I q I_()I <br /> O I q <br /> SWIS /` Inspection Number on the associated Survey form(Page 1) <br /> Number: F - FTI Photos Taken Q Yes Q No <br /> Property Owner <br /> I I t_ __ <br /> Blame Phone Number ✓alGng Address Clty State ZIP Coda. <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 /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ®Excluded Q Unpermitted <br /> (a 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water 8 used for bumpers or ballast Facility Type(Fill one) <br /> O 14 CCR§18420(a)(4)-Tire retreading facilitywith no more than 3,000 waste tires on premises O 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 /> n 14 CCR§18420(a)(7)8(e)-Tire dealer storing no more than 1,500 waste Gres 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 00 14 CCR§17352-Site Security <br /> 01 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 00 14 CCR§17353(a)-Vector Control <br /> Q O PRC§42850(a)-Complies With Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> 0 Q 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> Q 0 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 p(f)Siting(New Facilities) <br /> 014 CCR§18447-Records Available O(g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply O O 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d)Other <br /> Requirements _[ Facility Compliance with NFPA 231 DJ�1989 <br /> Comments f <br /> ril WLL��r <br /> b2. X11 <br /> cll �Q in pow Q n �c�s <br /> iyl 64e r' ` f hauQ�� -b Treor+ tires `to fd�sA� <br /> L1r I .des at a �v �.sposc .Q a.eclU# or <br /> o e�SS <br /> . Ca LFR <br /> e <br /> of Nell oF dire _frak-SCO(t o r re yL0 VAi e <br /> I 15386 <br /> INSTRUCTIONS ON BACK Correct:� Incorrect: I EIX I A IMI P I L I EI 11-112131 ■ <br /> ■ White Copy:CIW ME Yellow Copy:Operator Pink Copy:LEA <br />