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Alvey <br /> Waste Tire & Inspection Re -t <br /> State of California SURVEY REQUIRED . <br /> = � <br /> CIWMB 182(New 04/04) <br /> California Integrated Waste Management Board Inspection Form - Pagee 2 <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 00 U Report !� <br /> Number: j o V 1 <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m Photos Taken 0 Yes 0 No <br /> Property Owner <br /> tPo p�(Y �Iif� r?cckinj, r <br /> Name Phone Number Mailing Address City State ZIP Code <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> 10 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> I <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Excluded 0 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 /> 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises 0 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 /> 1,0 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 T 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit0 (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 /> 0 0 PRC§42850(a)-Complies with Terms of Permit <br /> 0 (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit <br /> 0 (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit 0 (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 /> Recordkeeping Re uirement 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 14 CCR§17351 -Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements I Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> hove hea S{a al... o(9." S; e Ic Ldo C�- <br /> Whe--1h(c Wy —fires Come #om �-(V s' i f;. <br /> r � <br /> �11 � 10 CQtI(1 � ���1�cf ,pi(k c�/�; or ' ye �f? s Y-6 <br /> 0 iCAo-einf 6t- Q4- adrocieoI �, IS urr��ol111 iYl viol ilr'C"fl p� <br /> u � C ire1ot cy- Skoict oY-(1 , d4ve -fz haviyhO 0(e `IAC4r 1 560 <br /> INSTRUCTIONS ON BACK [Correct:0 Incorrect: ( Er! Ai;'M P L 1 (� 15386 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br /> L t <br />