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I - <br /> vo262050030 <br /> Waste Tire Survey & Inspection Report uR E EauIREo <br /> ttt Waste <br /> calffomia <br /> CrWMB 182� om (N—ell <br /> integrated Waste 4n&" rnt Board Inspection- Form - Page 2 <br /> Part C-FaCilltv Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> inspection f I� <br /> Siete Suffix: Q' 2 1 13 �" Report <br /> �-� Number: <br /> SMSEll- - Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes •No <br /> 1= <br /> Property Owner <br /> �2n,a P.ione r!umbsr i/-•,,,g Aid ass City Stave LIP Cod= <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status(Fill one) <br /> Q 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 /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded Q Unpernitted <br /> Q 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 Q Major WTF (?5,000 Tires) <br /> • 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> Lo 14 CCR§18420 a 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 days Q Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V . A W STE R S O E D S V <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permiti O(a)Signs O(b)Site Attendant O(c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> �. Q Q 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> Q O 14 CCR§18423-Filing Application for Permit O(b)Fire lanes <br /> Q Q 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> Q Q 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)Slope/Grade <br /> Recordkeeping Requirement <br /> O(1)Siting(New Facilities) � <br /> Q Q 14 CCR§18447-Records Available O(g)Rim Removal <br /> 01 Q 14 CCR§17351-Fire Prevention Measures O(h).Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply 00 14 CCR§17356-Indoor Storage . <br /> O(b)Fire Equipment O(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments } <br /> -�o --V-•a(.�,-�-s'�..� a� C.e->'. u�_s�i as-�� <br /> INSTRUCTIONS ON BACK Cor t: Incorrect: E X A M P L ; ! 2 3 E 15386 <br /> ■ While Copy,CI7 <br /> Yellow Copy.Operator Pink Copy.LEA ® ■ <br />