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Waste Tire SiSey & Inspection Rept SURVEY REQUIRED <br /> R <br /> ■ -: State of California _ __ _ , ■ - <br /> -Inspection Form Page 2 <br /> CIWMB 182(New 04104) <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN ' <br /> Business Profile Inspection Details <br /> TPID- + ( ( ( f Inspection _ <br /> Site Suffix: 1 �T % ; fj - O ' I Report I - O r .� / <br /> ('E� <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m Photos Taken Yes Q No <br /> Property Owner f t f- <br /> _ 1 �7 � �. /24c1�� tl'�7 �l s iq Ir `1 J c Lh .,Lo�( p <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 Q permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded (J) Unpermitted <br /> I <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 /> Q 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 /> t <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§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days I <br /> Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility - <br /> V A : WASTE TIRE STORAGE STANDARDS _! V A <br /> Permit Requirements 4 14 CCR§17352-Site Security <br /> O Q PRC§42824-Major Waste Tire Facility Permit V(a)Signs O (b)Site Attendant C (c)Access <br /> (& 0 PRC§42834-Minor Waste Tire Facility Permit 7 14 CC §17353(a)-Vector Control <br /> 0 Q PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier O (2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q O 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes f <br /> O Q 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> I O (d)Drainage t <br /> 01O 14 CCR§18433-Emergency Response Plan <br /> O (e)Slope/Grade . <br /> Recordkee ing Re uirement O (f)Siting(New Facilities) <br /> 0 O 14 CCR§18447-Records Available O (g)Rim Removal <br /> i <br /> C' 0 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic'Oil Runoff <br /> 1 O (a)Communication Equipment Q (c)Water Supply 14 CCR§17356-Indoor Storage <br /> (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231D-1989',, <br /> Comments �ta U P A i lel u# �TL <br /> 10y %(d RuLsfe Ode ; or i06A v«, <br />` V Il1�t� Ss ly COO 1$qS�t�3 cod 1- 35r;� <br /> `ToCyr(ed- above violafrvy,S 06bye . foe,(U+,_I mwu ' ✓ed.cf!'� of ( G'Je <br /> 0,.+1d KLC O( r) � 10 1 500, Comply K)'A � I q C C(Z 5 5 1:7 1 <br /> a�1)11eHiby) +c1 U, f V, of obia.tn Ryw)if as a AfloT ( T �Gc� l .� ti <br /> Oln . � wilk I O AO Id IYC ,k Gvt '4S. �Qe �I- IDI'�_7(rD a� fe <br /> 1 J t J <br /> � s l J 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: , ''��; I- .(_ 1 C' <br /> ■ - ® ■ <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />