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Waste State of a SURVEY REQUIRED <br /> Tire I- �rvey & Inspection Reort � <br /> ED <br /> CIWMedWast(New Manag) Inspection Form - Page.2 <br /> Califomfa Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile ii11 Q Inspection Details <br /> TPISite - 1 o V 0 r-y - ® 'Repornspect <br /> I _ r� � I <br /> Site Suffix: ( Re ort <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: ' Photos Taken Q Yes Q No <br /> Property Owner <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 /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 411,Excluded Q Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> Q 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 /> Q 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> V 14 CCR§18420 a 7 &(e)-Tire dealer storing no more than 1,500 waste tires for 90 days O Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> VI A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> O O PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> O O PRC§42834-Minor Waste Tire Facility Permit 00 <br /> 14 CCR§17353(a)-Vector Control <br /> Q (1)Impermeable Barrier O (2)Approved Vector Plan <br /> Q PRC§42850(a)-Complies with Terms of Permit <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> O O 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> OQ 14 CCR§18447-Records Available Q (g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures (h)Protection from Pyrolytic Oil Runoff <br /> •(a)Communication Equipment Q (c)Water Supply 010 14 CCR§17356-Indoor Storage <br /> Q(b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> t t ' r QJ 6MDAN , <br /> T -� , , <br /> rJ <br /> 3_ PCulkA4 u.SF-s w - �s r W4sL , <br /> ,( ^�� 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: 'Aj ��j, q/) t�+� rel P 1 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />