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090490rJ0021 <br /> E;3_ Waste Tire Survey & Inspection Report <br /> iii... StateofCellio"la p p SURVEY REQUIRED <br /> CIgrat dW steMana4) Inspection Form - Page 2 <br /> CalHomia InCIWM d Waste Management Board <br /> Part C-Facili Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection m <br /> Siete Suffix: T o y 3 3 O r Report I 1 - I o g g 8 <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m Photos Taken ®Yes O No <br /> Property Owner <br /> L.4!110 f-�q_A _(0 9� 9'�-�i4� r3aS S Ce fir S+ S -b�,c�R sac�6 <br /> Name V Pho.,a <br /> NNumber Mailing Address City State Zee <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 O Permitted 0 Exempt <br /> Excluded Business Types(Fill If applicable). <br /> i <br /> 0.PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0.Excluded 0 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 /> O 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises D Major WTF (?5,000 Tires) <br /> O 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 days ®Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V A WASTE TIRE STORAGESTANDARDS ! V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 Q PRC§42824-Major Waste Tire Facility Permit 0(a)Signs Q(b)Site Attendant 0(c)Access <br /> ® O PRC§42834 Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> O O PRC§42850(a)-Complies with Terms of Permit 0(1)Impermeable Barrier Q(2)Approved Vector Plan <br /> 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> ® O 14 CCR§18420(a)-Applicable for Permit 0(a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit 0(b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> (d)Drainage <br /> O O 14 CCR§18433-Emergency Response Plan 0 <br /> �(e)Slope/Grade <br /> Recordkeeping Requirement Q(f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0(g)Rim Removal <br /> 0 Q 14 CCR§17331-Fire Prevention Measures 0.(h)Protection from Pyrolytic Oil Runoff <br /> (a)Communication Equipment Q(c)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> 0(b)Fire Equipment <br /> 0�(td')�Other Requirements <br /> Facility Compliance <br /> ompliance w'iith e NFSPA 23113-1989 <br /> Comments / W-as —eLj`ce 'Ify Permit ' Qm -f�e CW m& <br /> Sfe � em . i� v� �cl� hs b�Af <br /> rg-S <br /> _ -b <br /> C)!l ecf- <br /> r i.s(aosa1 . MsVifWM' �r was+e_ -tire-5 c , Sposect of <br /> Go 1 olt;vi C3u Product's, a nd was+��i�r�,S 1�ro kf Si+e. <br /> I eV 10 i!kn o N- PR e � L4 2g3- m,h or- ]a �77m F'Ic C�fP��M _ <br /> o _w LA" N - ISI CCI__R I gy 2oLA___,4Po 1'►�_c�)I? r �rM► �" <br /> F06 k�y_ I.!� G4►'mac f-ed_ lz� c Gf h q M 1'h 0 r I/l)cuSYIl i(fie <br /> ' <br /> INSTRUCTIONS ON BACK G-orrect: Incorrect: E:(X R M P E 2 2 3 15386 <br /> ■ White Copy:CIWMB Yellow Copy.Operator Pink Copy.LEA ® ■ ' <br /> I <br />