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= E__ .• Waste Tire ' ey & Inspection R441 SURVEY REQUIRED <br /> t. State of California ■ <br /> CIWMB 182(New 04/04) 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 /> 101 <br /> (� t Inspection �] <br /> Ste Suffix: 1 r� Report <br /> Number: <br /> SS Inspection Number on the associated Survey form(Page 1) <br /> Number: m m Photos Taken Q Yes No <br /> WI <br /> Property Owner <br /> � )�Ij� <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 I O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) C Excluded O Unpermitted <br /> O 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 /> O 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 14 CCR k18420 a 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 da)LS O Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility. <br /> V A WASTE TIRE STORAGE STANDARDS i V A <br /> Permit Requirements 0 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 /> Q I O PRC§42834-Minor Waste Tire Facility Permit 14 CCR§17353(a)-Vector Control <br /> Q II 0 PRC§42850(a)-Complies with Terms of Permit � O (1)Impermeable Barrier O (2)Approved Vector Plan <br /> 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units <br /> 01 O 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 01 Q 14 CCR§18432-Operations Plan <br /> O (c)Fire District Requirements <br /> Q; R§18433-Emergency Response Plan O (d)Drainage <br /> 14 CC <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> O o 14 CCR§18447-Records Available O (g)Rim Removal <br /> i 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment O (c).Water Supply14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> ,`/ �� �'� 1 _ ��� .���� ; r� YA . l <br /> 1 { t-, A <br /> I r <br /> ' i <br /> �J � 15386 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: ( ) � � � 1�1 P � E 1112'.. ;� <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br /> I <br />