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10041.0SO014 <br /> Waste. Tire Survey & Inspection Report suRUEY REQUIRED <br /> n rtiI StateB182omia Inspection Form. -. Page 2 <br /> CIWMB 182(New 04104) p <br /> California Integrated Waste Management Board <br /> Part C- Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection w <br /> .Site Suffix: I —�—� - Report <br /> Number: <br /> SWIS ' Inspection Number on the,associated Survey form(Page 1) <br /> Number: 1 I I - - Photos Taken Q Yes - Q No <br /> Property Owner <br /> ,,l�efold_dcannuc�_ — ,�1�4J�11o_10-18b1, �.:-.P.0,,-4v� <br /> ame I� cn uimi a a,urrg Ac;rt;ss City Sr:c 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. O Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded 49 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> 0 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 /> 0 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 8 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 /> A WASTE TIRE STORAGE STANDARD'S V A <br /> Permit Requirements 00 14 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 /> O PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit 0(1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> I- <br /> O O 14 CCR§18420(a)-Applicable for Permit 0(a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit 0(b)Fire Lanes <br /> t O O 14 CCR§18432-Operations Plan 0(c)Fire District Requirements <br /> O O 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> 0(e)Slope/Grade <br /> Recordkeeping Requirement 0(f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available 0(g)Rim Removal <br /> O 0 1 14 CCR§17351-Fire Prevention Measures 0(h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment 0(c)Water Supply 010 1 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0(d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> --�I)-aunale.-c �Lot �GI1Nr�a) g CO-�1�IAC,1 �.�-oif1wSTe <br /> ��i�c_eLQyS�f*-, c�Ii�o� �1c�� �� � ilin'Ao o� <br /> (M� A)J,ocv"__ ��—46-9 "iuk�-S,_P 1�trA—�(`-�1.L�1e_�__o_c� E1� a�ca_tn <br /> GOSA;n br cin ��11 6��(1uli�S j C UVn14 l tl ccr� e-c�V S �_ <br /> _ cq) alliCe_ci(1�i _L�eSe."L C� cflcu _V_ -PfoSe <br /> Gn_km c 6k Q al pc�r�i�Ln.ef, f1_T Lwc�nQ�ie Y1�AR CL� S <br /> INSTRUCTIONS ON BACK C-orreet: Incorrect: X R M P 'L E 2 15386 <br /> 2 3 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />