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Waste Tire Slvey & Inspection Rei 't SURVEY REQUIRED <br /> State of California <br /> CIWM6182(New 04104) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Inspection Details <br /> TPID- Inspection <br /> Site Suffix: ' �' - C; , Report <br /> Number: _ <br /> SWIS mw <br /> Inspection Number on the associated Svey form(Page 1) <br /> Number: �J m Photos Taken Q Yes 0 No <br /> Prope <br /> < i <br /> ^t <br /> I, t �-(J) �I ,� �1 it �L�J /�(� 1`/�I� c•,, yc 1 � <br /> N�,i,. Phone Number Mailing Address city I State ilP Code <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O Permitted 0 Exempt <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded ® Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast <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 days 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 4 CCR§17352-Site Security— <br /> O O PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> (u) Q PRC§42834-Minor Waste Tire Facility Permit �l <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> Q Q 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit 0 (b) Fire Lanes <br /> 0' Q 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> Q Q 14 CCR§18433-Emergency Response Plan 0 (d) Drainage <br /> 0 (e)Slope/Grade <br /> 0 (f)Siting(New Facilities) <br /> Q 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 <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X Im X A 14 I_ [- i L <br /> .I <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />