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Waste Tire vey & Inspection Re, 't SURVEY REQUIRED' <br /> - State of California <br /> =� <br /> CUM B 182(New 04/04) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: ` , Report I - J b / -q \ O <br /> Number: b / <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - - Photos Taken 0 Yes 0 No <br /> Property Owner <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 0 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 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 CCR§18420(a)(6j-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 0 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 /> V A WASTE TIRE STORAGE STANDARDS _ V i A <br /> Permit Requirements 0 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O (a)Signs 0 (b)Site Attendant 0_ (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit I 0 0 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 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 /> 0 0 . 14 CCR§17351-Fire Prevention Measures I 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 10 ® 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> ��-ti l.�vti\ �-c�j 1� 1.t..� L'c. '�---t..v �u•-r=\ ���i� ;7 >r-_9��µ-in—v�-cv�__,�, <br /> 5 <br /> eL i/ ems. e i\`u-c,, S l cv.� ; Q�c�i.t. wA JJ <br /> '' V�--`—\l \�`� �" ""ti"� V r�.7��-�cw►-tr-t�J��ei,� `v->--u.� i.L�--�-� L ov�"�--3� .. <br /> CL-S <br /> ---- ---- - -- -...... -- � / 15386 <br /> _ <br /> INSTRUCTIONS ON BACK CorrectIncorrect_ (�, V J E X1 A MI P L;E 11 2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />