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City/County Waste 'tire Survey and Inspection Repo. Mailing Address Eiw Oe ,III Cliyi+— Phone Number State of California �' Y CIWMB-54(10/03) PART A -General Information/Survey Page I of "L 1Rug :'t ti';' INSPECTION/SITE VISIT 44"', It' Type(Check one). d Routine ❑ Re-inspection ❑Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: Inspected by: Time In:. Dat Regulatory S!29 4: File No. TPID: ❑County/City L,-,ZLI� { ❑Permitted Excluded[I Exempt❑Unpermitted Code: Time Out: Total Tfine: O erational Status: Local: Hauler ID: + El State I VActive❑Closed C]Inactive E]Planned Business/Facility Name: Tire Count: Ty AtAiv 1—r-ly �vt,� 5-� Passenger❑Altered❑Truck❑OTR Address: �/ l/�1 ` I n Phone: St ge Type: 7,g L_ LOctC�+ Ave— tz J, GSI `15724°U 369-060S dd outdoor❑Indoor❑Container Owner: Inspect r(Please Pr i t): Business Rep: Title: Facility Type:(cheek one) v Role/of Business:(cheek all that apply) ❑Major WTF(>5,000 tires) ❑ Minor WTF(>500 tires) ❑Waste Tire Location (,500 tires) Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) [J Tire Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ❑ Gas Station ❑Trucking Fleet ❑Shredder ❑Crumb Rubber ❑Other: Describe Excluded Business Types(check only If applicable): ❑ 14 CCR§18420(a)(3)-Facilities storing less than 500 waste tires(Waste Tire Location). ❑ 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises. ❑/ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. (U 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from permit,complete Parts B and D. If not excluded from permit requirements complete Parts 8,C,and D. PART B Ins ection of Waste Tire Dealer, Generator, Hauler and End-Use Facility me `�IAUL`IN6PANfY�MA�IIF�'�,_ . . ._ bSTit��(3 REQUIREMkNTS�. . . ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ 14 CCR§18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. ❑ ❑ ❑ 14 CCR§18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. ❑ ❑ ❑ 14 CCR§18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C — Inspection of Waste Tire Facility V A,1; C `;J,'=,WASTE TIRE STORAGE STANDARDS V I A C WASTE TIRE STORAGE STANDARDS Permits Requirements [ [ [ 14 CCR§17352-Site Security ❑ ❑ ❑ PRC§42824-Major Waste Tire Facility Permit ❑ (a)Signs ❑(b)Site Attendant ❑ (c)Access ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)-Complies with Terms of Permit [ I [ I [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§ 18420(a) —Applicable for Permit ❑ (1) Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 —Filing Application for Permit [ I [ [ 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑ (a)Storage Units ❑ ❑ ❑ 14 CCR§18432—Operations Plan ❑ (b)Fire Lanes ❑ (c) Fire District Requirements ❑ ❑ ❑ 14 CCR§18433—Emergency Response Plan ❑ (d)Drainage ❑ ❑ ❑ 14 CCR§18447—Records Available [:1(e)Slope/Grade C] [ 14 CCR§17351 -Fire Prevention Measures E)(f)Siting(New Facilities) ❑(g) Rim Removal ❑(a)Communication Equipment ❑(h)Protection from Pyrolytic Oil Runoff ❑(b)Fire Equipment [ I [ I [ 14 CCR§17356 -Indoor Storage ❑(c)Water Supply ❑(d)Other Requirements Facility compliance with NFPA 231 D-1989