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- �735405001� <br /> rrra Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> ■ ••-➢➢� State of Califomla ■ <br /> C. asteManIla) 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 /> ------_—T._--- ------------ -- �---I <br /> TPID- r� I / I <br /> In �T /n <br /> Site Suffix: ' 3 / O I I I �1/— O_/� NReport <br /> umber: L _�w� _ �_ ' O -�1�✓ I-31 <br /> SWIS Inspection Number on the associated Survey farm(Page 1) <br /> Number: Photos Taken 0 Yes 0 No <br /> Property Owner <br /> Veme �Phoneyrvumher--- mailing Address City ---- State ZIP Code <br /> Exempt Business Type .(Fill if applicable) Permitted Regulatory Status(Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill'rf applicable) <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 orballast Facility Type(Fill one) <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 /> I V I A I WASTE TIRE STORAGE STANDARDS IV A <br /> Permit Requirements 0 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O(a)Signs 0(b)Site Attendant O(c)Access <br /> 0 0 PRC§42834-Mina Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> 0 0 ! PRC§42850(a)-Complies with Terms of Permit (1)Impermeable Barrier Q(2)Approved Vector Plan <br /> 1 00 14 CCR§17354.Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0(a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> 0, 0 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> 0 I 0 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> 0(e)Slope/Grade <br /> Recordkeeping Requirement <br /> 0(f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0(g)Rim Removal <br /> 101 0 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff <br /> 0(a)Communication Equipment 0(c)Water Supply I 0 0 I 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment 0(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments / <br /> 5 n p r eS z s�. �IGL�Nl1 S iia c rtA OA 'ex_vtp Oti <br /> CvIla%ef Aa",/('AA 1� <br /> �YpL`i S�ort ars 1eZ �v"e_S c,� <br /> I TLt. 2 Q.5 aer S�> V i Lto,- eo nf'o I wa S C�S C" I e�t�i <br /> 'le of nar4h of proPe�4y. Fac,l::k _ivm <br /> �,f as '-� .4b �e # 0 a0_q ) � <br /> Mires an _5 fe. <br /> I 'I <br /> INSTRUCTIONS ON BACK I Correct:0 Incorrect: C9 I EpXI AQMI P I L I E1 I I pp 12131 15386 <br /> ■ White Copy CIWMB Yellow Copy Operator Pink Copy:LEA ® ■ <br />