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07312030028 <br /> Waste Tire Survey & Inspection Report SURVEY REQ�I IRED <br /> ,••11- Stals of Califomla ■ <br /> CIWMe,^:trb.o.,a, Inspection Form - Page 2 <br /> Cal orn Intagnted Waata Manag—rit Board <br /> Part C-Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID• 16? <br /> T— Inspection <br /> Site Suffix: I O I S I l0 1 l-_� ReportFoT�1 ,3� <br /> 31 Number: (79, <br /> SWIS �Irn�I I Inspection Number on the associated Survey form(Page 1) <br /> Number: �-- Photos Taken Q Yes ®No <br /> Property Owner -- -- <br /> . I...._ _.___— _-._.___J <br /> ��larne Prone A'Umber �feiG„gAdtiress---- —city Sate ZI?Cnoe <br /> Exempt Business Type (Fill it 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) ®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 /> ®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 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> Q 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days Q Minor WTF (WO-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V A ASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements Q 01 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit 0(a)Signs 0(b)Site Attendant 0(c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit Q Q 1 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit 0(1)Impermeable Barrier 0(2)Approved Vector Plan <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§1 a420(a)-Applicable for Permit 0(a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit 0(b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan 0(c)Fire District Requirements <br /> 0(d)Drainage <br /> Q Q 14 CCR§18433-Emergency Response Plan <br /> 0(e)Slope/Grade <br /> Recordkeeping Requirement <br /> Q(f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available 0(g)Rim Removal <br /> Q 10 1 14 CCR§17351-Fire Prevention Measures 0(h)Protection from Pyrolytic Oil Runoff <br /> 0(a)Communication Equipment 0(c)Water Supply Q 10 14 CCR§'17356.Indoor Storage <br /> 0(b)Fire Equipment 0 <br /> (Cd)Othei Requirements FacilityCompliance with NFPA 231D-1989 <br /> Comments -1 !., ,se o C <br /> fv, C _v(r bS loca;t anS hof'.-A bCeYrec ; -h <br /> �fJ�Qj � S <br /> L7LS utl�✓e nas of <br /> %k i.�f ill s o� b f �&e C7Z.s v�/er� �rowt 200_0. All <br /> X0.7 ase Fi l d e cin t� zeilL rS <br /> { f 0►� �_ o✓i pT1e r�JQs f,]-es OGet 'o�e> a �a A <br /> W"D''—Ca _ S l7 or hcrl-�s t uI <br /> rho -- _rte Wd CIL�-fY- -- soov�. I�1 o_✓_it Jaz CSX S tL - <br /> INSTRUCTIONS ON BACK Corn eYl� I c•rr •t: IEIX A M P L E 1[2� 15386 <br /> ■ White Copy CIWMB Yellow Copy.Operator Pink Copy LEA ® ■ <br /> I <br />