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. " Waste Tire S. ✓ey & Inspection Rep9t SURVEY REQUIRED <br /> iiiiA State of Califomia <br /> ---" CIWMS182(New041D4) Inspection Form - Page 2 <br /> Cal(oma Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Q c�+n ,���p� Inspection Details <br /> TPID- �--- Inspection <br /> Jl i i < � 5'' Zi <br /> Site Suffix: >:7; �' r] Report I - f 0 I <br /> L+ �' '7 - - — Number: L - — - l--- <br /> SWIS i 1 fnspec ion Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes ® No <br /> Property Owner <br /> , �� � S►,�.�,e.— _ zea-abs-427$ •Z3z43 N _Ro .2 2.Q, 4'CdAl , cq 9s2.142_! <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) Q Excluded Q 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 /> 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 /> 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 storingno 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 /> V1 A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements Q Q 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 • PRC§42834-Minor Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> Q (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> Q Q PRC§42850(a) Complies with Terms of Permit Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(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 0 (f)Siting(New Facilities) <br /> 0 Q 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> Q Q 14 CCR§17351 -Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 010 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d')Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments 1+Z-2�4 /no.- wig 777 — <br /> j at 6 Lv C' IA,:;,t cpt _4r-- <br /> YN <br /> __T <br /> Lip <br /> L <br /> INSTRUCTIONS ON BACK Correct: Incorrect: (� � X A hh R E 12 3 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />