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-•�nip��—�.., <br /> ■ d,Waste Tire Survey & Inspection Report SURV+EY R QUIRED <br /> State of CaliromiaCI Mt1d 12tNew nap Inspection Form - Page 2 <br /> Megratmr Wast-Management Board <br /> Part C-Facili Information _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID• - pection <br /> Report Suffix 1 Q q '5 1 � ' - 10 <br /> — - -19- O OQ <br /> SWIS <br /> Number: ! ; Inspection Number on the associated Survey form(Page 1) <br /> Num - ! - Photos Taken 0 Yes 0 No <br /> Property Owner <br /> Jerold Bywi noh �04)W43-3�0'l at i e • Cka.Y-tev- v)&J,Siac,le+C0 9 S <br /> Exempt Business Type (Fill If applicable) permitted Regulatory Status (Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with writte=n 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 Unpennitted <br /> 10 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water ii 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 Gres 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 Gres for 90 days ®Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> Y 1 A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 1 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit I O(a)Signs O(b)Site Attendant O(c)Access <br /> • Q PRC§42834-Minor Waste Tire Facility Permit 00 1 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> 00 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 /> 0 Q 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 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment-10-r <br /> n'` JO(d)Other Requirements"o�dt <br /> _r Facility Compliance with NFPA 231D-1989 <br /> Comments '—0- 10- AJ—, L'-4L__ iJ� ��I <br /> we- Ke—sek-t <br /> I �arcQl (AP�1 15youo )_i�vcaiccys ., -- <br /> wl �-1•►�•t_ Ate. d+��sS �o$!_�,Cha/tfe/- trPl.�97 -or and o�. �t.+`Fer <br /> vvel-t on racks , N_o�as-l-e. -fires wereybsu-vecl. 411 IS o� site <br /> � rd lEse -lra,'Kers v_Verd10 W4 e <br /> ■ INSTRUCTIONS ON BACK Correct:� Incorrect: X R M P L E I Z 3 15386 <br /> hits :CIWMB Yellov+ Copy OpCrator Pink Copy:LEA ® ■ <br />