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NEZ�, <br /> Waste Tire SlOvey & Inspection Rei suRVEY REQUIREDJ <br /> "a State of California <br /> CIWMB 182(New 04104) Inspection Form - Page 2 -_--� --- <br /> Cal ornia Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Site - �f - moo, Inspection — <br /> Site Suffix: / / v Rep I -6 <br /> Number: 0701317 <br /> SWIS Inspection Number on the associated Survey form Page 1) <br /> Number: - - Photos Taken 0 Yes 0 No <br /> Property Opner <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> 0 PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded ® Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> 0 14 C CR§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 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-dap- 0 Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> - <br /> A - - - <br /> WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 1 O(a)Signs O (b)Site Attendant O (c)Access <br /> ® 0 PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§17353(a)-Vector Control <br /> O (1)Impermeable Barrier O (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 O (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> 00 14 CCR§18447-Records Available O (g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O (a)Communication Equipment O (c)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> n s <br /> A14— <br /> w <br /> INSTRUCTIONS ON BACK , E X A"MI P L E 1 i 2 3 ■ 15386 <br /> White Copy: MB ellow Copy:Operator Pink Copy:LEA <br />