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Wastea Tire Su. Bey & Inspection Rept SURVEY REQUIRED <br /> State Ofs i <br /> CIWMB182(New04104) <br /> California IntegratedWaste Management Board Inspection Form - Page 2 - <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> - `A r _ Inspection <br /> Site 2- r /1 <br /> Site Suffix: "1 t7j Report I 1 — l Z � V <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes O No <br /> Property Owner <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> O PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exerription O Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q Excluded I• Unpermitted <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 /> O 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 /> Q 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 0 Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> VI A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 001 14 CCR§17352-Site Security <br /> O Q PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> O 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> Q 0 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 /> 0 Q 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> 0 Q 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 Q 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan Q (d)Drainage <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement Q (f)Siting(New Facilities) <br /> 0 Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> Q Q 1 14 CCR§17351 -Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment Q (c)Water Supply Q O 14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> INSTRUCTIONS ON BACK [Crriect, Incorrect: (� e A P �_ ! 1 ° 2 3 15386 <br /> White Copy:CIWM6 Yellow Copy:Operator Pink Copy:LEA <br />