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Waste Tire %vey & Inspection R#rt SURVEY REQUIRED <br />1 State of California <br />ii CIWMB 182 (New 04/04) <br />Inspection Form Page 2 -_ <br />California Integrated Waste Management Board <br />cart c - I-acliny IniOrmazion oLVG VR oLr%%.F% IINF% rG1Y <br />Business Profile Inspection Details <br />TPID -` Q Inspection <br />Site Suffix: l 3 O 5 ® I Report I <br />Number: 3S 1 <br />SWIS Inspection Number on the associated Survey form (Page 1) <br />Number: Photos Taken 0 Yes 0 No <br />Owner <br />Exempt Business Type (Fill if applicable) <br />0 PRC § 42823.5 - Cement Manufacturing Plant with written verification that the facility qualifies for exemption <br />Excluded Business Types (Fill if applicable) <br />0 PRC § 42808 - Permitted Solid Waste Facility (Landfill, Transfer Station) <br />0 14 CCR § 18420 (a) (2) - Agricultural < 5,000 tires incapable of holding water & used for bumpers or ballast <br />0 14 CCR § 18420 (a) (4) - Tire retreading facility with no more than 3,000 waste tires on premises <br />0 14 CCR § 18420 (a) (6) _ Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br />In 14 CCR § 18420 (a) (7) & (e) -Tire dealer storing no more than 1,500 waste tires for 90 days <br />Part n - Insneetion of Waste Tire Facilitv <br />Permitted Regulatory Status (Fill one) <br />0 Permitted <br />0 Exempt <br />Is Excluded <br />0 Unpermitted <br />Facility Type (Fill one) <br />0 Major WTF <br />(_> 5,000 Tires) <br />0 Minor WTF <br />(500 - 4,999 Tires) <br />V1 A I WASTE TIRE STORAGE STANDARDS <br />V <br />A <br />Permit Requirements <br />00 <br />14 CCR § 17352 - Site Security <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />PRC § 42824 - Major Waste Tire Facility Permit <br />PRC § 42834 - Minor Waste Tire Facility Permit <br />PRC § 42850(a) - Complies With Terms of Permit <br />14 CCR § 18420(a) - Applicable for Permit <br />14 CCR § 18423 - Filing Application for Permit <br />14 CCR § 18432 - Operations Plan <br />14 CCR § 18433 - Emergency Response Plan <br />- <br />O (a) Signs O (b) Site Attendant O (c) Access <br />• <br />0 <br />14 CCR § 17353(a) - Vector Control <br />0 (1) Impermeable Barrier O (2) Approved Vector Plan <br />00 <br />14 CCR § 17354 - Storage of Waste Tires Outdoors <br />Q (a) Storage Units <br />O (b) Fire Lanes <br />O (c) Fire District Requirements <br />Q (d) Drainage <br />O (e) Slope/Grade <br />0 (f) Siting (New Facilities) <br />0 (g) Rim Removal <br />O (h) Protection from Pyrolytic Oil Runoff <br />Recordkeeping Requirement <br />0 <br />0 <br />14 CCR § 18447 - Records Available <br />0 <br />0 <br />1 14 CCR § 17351 - Fire Prevention Measures <br />O (a) Communication Equipment Q (c) Water Supply <br />• (b) Fire Equipment 0 (d) Other Requirements <br />00 <br />14 CCR § 17356 - Indoor Storage <br />Facility Compliance with NFPA 231 D-1989 <br />1 <br />Comments s .,' 1 LI %-o J C" N e� ... C) �p f -g d�� ^% /� <br />r7� • n(1- 11 n__ __ ---- <br />(� t�ia� �1.�1nc1 �Cyfh pSc,J; city inSQ � � �1- <br />vu��wb1.�, One oak s �Pli <br />CL IN <br />A t) 09A CLA A) C4 S ta D) <br />INSTRUCTIONS ON BACK Correct: Incorrect: (� I �h 15386 <br />0 White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA ® ■ <br />