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J,Waste Tire Survey & Inspection Report <br /> Stats of Callfomla <br /> CIWMB 182(New 04104) Inspection Form - Page 2 <br /> ntegrated Waste Management Board <br /> Part C-Facility Information _ _ BLUE OR BLACK INK PEN <br /> Business Profile (insissoon Details <br /> T . <br /> Suffix: t a g 0 g 5 - o l ��°rt 1 - r D 0 fo 6 1 9 <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken 0 Yes O No <br /> Properly Owner <br /> -"aseph P naso Ltq 53 JER YACHT {fOW-DR S?'OClc A) <br /> 93aoq <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status(Fill one) <br /> O PRC§42823.5-Cement Manufacturing Plant with written verlflcetlon that the facility qualifies for exemption O Permitted O Exempt <br /> Excluded Business Types(Fill If applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded 0 Unpernitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires Incapable of holding water&used for bumpers or ballast Fadl tyType.(F6 ore) <br /> O 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises •µajprWTF (>5,goo Tires) <br /> O 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> IO 14 CCR 420(a <br /> §18 )(7)&(e)-Tire dealer_storingno more than 1,500 waste tires for 90 days O WTF (500'4,998 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> Permit Requirements 01O 14 CCR§17352-Site Security <br /> — — — <br /> ® O' PRC§42824-Maj«Waste Tire Facility Pemlil _ O(a)Signs O(b)Site Attendant O(c) <br /> O O PRC§42834-Minor Waste Tire Facility Permit O O 14 CCR§17353(a)-Vector Control <br /> Access <br /> O O O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> PRC§42850(a)-Complies with Terms of Permit •. O 14 CCR;17354-8foraDe of Waste Tires outdoors 1 <br /> O 01 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> O OI O(d)Drainage <br /> 14 CCR§18433-Emergency Response Plan <br /> O(e)Slope/Grade <br /> Recordkeeping Requirement O(f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available 0(g)Rim Removal <br /> 01 01 14 CCR§17351-Fire Prevention Measures O(h)Protection from Pyrolytic Oil Runoff — <br /> Q(a)Communication Equipment Q(c)Water Supply Q O 14 CCR§17356-Indoor Storage <br /> O(b)Firs Equipment O(d)Other Requirements Facility Compliance with NFPA 23ID-IM <br /> coss"'a`' CC Imbese 4ire5 are on rims. Tires 'an`dr"s used as E20144t to <br /> hold U„s oFF around. 3200 ears on pin mi ses, <br /> VIOLAnom • PRC% 1428A - rkility does not have Malar Waste Vire <br /> F0.Ci liy PlItrn,11 i+ _ <br /> emtaet Tern -Srn" at 10IW/48 hr permit aYpliearHon w <br /> 91(0) 3w-6yA/1 <br /> INSTRUCTIONS ON BACK E!X P I 01112T3 <br /> 15386 <br /> . White Copy CIWMB Yellow Copy Operator Pink Copy.LEA <br /> 9529265.6046 <br />