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f Waste Tire rey & Inspection Ret SURVEY REQUIRED '' <br /> .-Co.Y.Ia State of California <br /> CaliforniaCIWMB1Wast(New anage Inspection Form - Page 2 <br /> ornia Integrated Waste Management Board <br /> Part C - Facilit Information BLUE OR BLACK INK PEN <br /> �., <br /> TPID --- Inspection _ -- <br /> Site Suffix: - Report <br /> F7l <br /> W <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken 0 Yes 0 No <br /> Phone Number Mailing Address <br /> fmpt Business Type (Fill if applicable) Permitted Regulatory Status {Fill one) <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that lice facility qualifies for exemption 0 Permitted 0 Exempt <br /> ypes(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Fac"slity Type(Fill one,) <br /> 0 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 CC R§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 <br /> Minor WTF (500 4,999 Tires) <br /> �O _ §_ O O O g v <br /> Part D - Inspection of Waste Tire Facility <br /> V I A WASTE TIRE STORAGE STANDARDS V A <br /> µ <br /> RIB ON f' ��1 0 0 14 CCR§17,. 2-Site Security <br /> WINES- <br /> 070 PRC§42824-Major Waste Tire Facility Permit O (a) Signs 0 (b)Site Attendant O (c)Access <br /> 0 PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§ 17353(a)- vector Control <br /> 0 (1) Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 , 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c) Fire District Requirements <br /> 0 0 14 CCR§ 18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement <br /> 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§ 18447-Records Available 0 (g) Rim Removal <br /> I 0 0 14 CCR§17351•-Fire Prevention Measures 0 (h) Protection from Pyrolytic Oil Runoff <br /> 0 a Communication Equipment <br /> 0 (c)Water Supply 0 0 - 14 CCR 17356-Indoor tinlr�r <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> -- • X �, _ 15386 <br /> INSTRUCTIONS ON BACK Correct: Incorrect: �.JMr P L <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />