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_ � f <br /> Waste_ Tire S1, rey & Inspection Re <br /> b Slate of California 0 SURVEY REQUIRED <br /> ■ <br /> IN: CIWMB Integrated <br /> steMana 4) 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 /> TPID- Lj Inspection <br /> Site Suffix: 011 <br /> 9 ! - 0 ' Reporto%1 <br /> Number: m <br /> SWIS Inspection Number on associated Survey form Pae 1 <br /> _ _ Y (Page ) <br /> Number: m m Photos Taken Q,Yes 0 No <br /> Property Owner <br /> Io vee n I 0 1 Cc S�t;C . -/jh '1 �1 <br /> Name �f�o� �eE Og p Ph(ne Number Mailing Address City $tate Z , Code <br /> Exempt Busine s 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 <br /> 0 Permitted 0 E empt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Excluded 0 U permitted <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 /> 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 CC R§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 /> V A WASTE TIRE STORAGE STANDARDS V i A <br /> Permit Requirements 0 14 CCR§17352-Site Security _ T <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 14 CCR§17353(a)-Vector Control <br /> (1) Impermeable Barrier ® (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit ® (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit @ (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> Recordlkeep!ng Requirement <br /> i 0 (f)Siting(New Facilities) <br /> I <br /> 0 i 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> h`. 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply01 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment fid)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> I <br /> Comments <br /> rel r°n�UVPG( j lei p he lc�t lcrs 1( t{r -Ole Jin Jotf1 <br /> IF <br /> J <br /> r�!)UVn( I,6� . u; et IIG CG �y� .Gt-)!I0 l /n r�ry<i.QS: rs� Yi� Fnr;llr_ a v. <br /> - t.tP .- .Y ft GtlF l`G tlPr S ct✓� t�lczC( ID <br /> J•.1 � ,'PC tE)>1 IJP `, r'i7rlCLti(-f�'C1 1y1 0P `omc Ul .Jc4ii'le >� rt�(�t�P'� OfL Fro AG�(�� 1 i4 <br /> CIP(Iurl p1 Lr_A.� �, �.a 06 vJ'A01'1cC 0f near( <br /> (fir- Vp lar CCT �vl o�cC( �i�✓� 'I <br /> boas ct d d o �'�G(i� �y�c Ct <br /> 1 b S E1 J U (A.)- rfc Ill, bu4f . <br /> akJ wey,e,. M01-oCf <br /> V 10/ �iorl ��I cod I'l (/PrlJr rcrll�c� <br /> INSTRUCTIONS ON BACK Correct: Incorrect: U� ��� 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />