Laserfiche WebLink
j <br /> J Waste Tire 90vey & inspection ReArt SURVEY REQUIRED <br /> State of California <br /> CIWMB182(New 04104)._ inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> i. Part C - Facility Information BLUE OR BLACK INK PEN <br />'�•` Business`Profile '.' Insp'ection:Detaiis , <br /> TPID- ( Inspection ---7 <br /> �i Site Suffix: l oReport <br /> Number:. <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: LJmPhotos I I I <br /> Taken 0 Yes No <br /> Property Owner <br /> 390 <br /> Name i hone Number Mailing Address City State 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 l <br /> 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) i <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q 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 /> Minor WTF (500-4,999 Tires) <br /> 0 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90.days <br /> Part D - Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGE STANDARDS �V A <br /> Permit Requirements 0, 0 14 CCR§17352-Site Security <br /> I 0 0 PRC§42824-Major Waste Tire Facility Permit O (a)Signs ' 0 (b)Site Attendant 0 (c)Access <br /> 10 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 i ® (1) Impermeable Barrier Q (2)Approved Vector Plan <br /> 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit i 0 (a)Storage Units <br /> ,,J0 0 14 CCR§18423-Filing Application for Permit I O (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> i O (d)Drainage <br /> 01 0 1 14 CCR§18433-Emergency Response Plan <br /> O (e)Slope/Grade , <br /> Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available Q (g)Rim Removal <br /> j 0i 14 CCR§17351-Fire Prevention Measures ® (h) Protection from Pyrolytic Oil Runoff <br /> lO (a)Communication Equipment .0 (c)Water Supply 1 ;'j 14 CCR§17356:=,Indoor Storage <br /> Q (b)Fire Equipment 0 (d)Other Requirements I — Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> fA)eVC_rbad� <br /> J J J - - <br /> CCf2��,Ccfi orl avid R" CC-, Go04 01-0oee 5 . AP hof1 d, Tron< <br /> Aztt eS�°S VIPr�JQd Q1,7Cl <br /> .1 t�(. 1 t �� ((n d J,id m-ry ✓Q:C t t�v 4 t C ""T pick 1. r U�,1 �t C.+l (a .._. <br /> iyor,/ logs ,,- Traa,�/�?ef�f � �(krc <br /> ?CA-0ACPr V P rk(`1PVJ �t:irF_ ': .D ff�1C'i. � <br /> F - <br /> Q(CcI-V 1 QJ I.pn C 1, coke C- t r (,�7� art cl C,-iL 1!P c/('ILti _— <br /> / 15386 <br /> INSTRUCTIONS ON BACK Correct:• Incorrect: (V) ` ) AA 3 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />