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01340050012 <br /> Waste Tire Survey & Inspection ReportSURVEY REQUIRED ■ <br /> ur <br /> Suit of <br /> • mla <br /> C"MB182(N. emnt Page- <br /> 2C.lilonla Intagmtsd WaStbMag BabIns Inspection Form - <br /> Part C-Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- f r Inspection <br /> I Site Suffix: (0o (I Report I I y — J b 2 3 13�? <br /> Number. I �J �__ <br /> SWIS _ T <br /> T I O t�� Inspectbn Number on the associated Survey form(Page 1) <br /> Number: 1 / Photos Taken ®Yes Q No <br /> Property Owner <br /> 1 9� <br /> ,nds, 1_ - __cTT`�.y__N. w799� �Sii �- �a <br /> �dzme Fimonen4nn�sr u;elhngAooress / C�iy � Sith ZTP—�coeJ <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status(Fill one) <br /> O PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption ®Permitted Q Exempt <br /> Excluded Business Types(Fill it applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded Q Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 Gres 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 O Major WTF (?5,000 Tires) <br /> O 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> l�14 CCR§18420(a)(7)8(e)-Tiredealer 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 WASTE TIRE STORAGE STANUARUS V A <br /> Pernit Requirements Q Q 14 CCR 117352-Site Security <br /> 0-0- PRC§42824-Major Waste Tire Facility-Permit _ 0.(a)Signs-- Q(b)Site Attendant , Q(c)Access_ . <br /> O O PRC§42834-Minor Waste Tire Facility Permit O O 14 CCR 117353(x)-Vector Control <br /> O Q PRC§42850(a)-Complies with Terms of Permit Q(1)Impermeable Barrier Q(2)Approved Vector Plan <br /> Q 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O O 14 CCR§18420(a)-Applicable for Permit Q(a)Storage Units j <br /> O O 14 CCR§18423-Filing Application for Permit Q(b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan Q(c)Fire District Requirements <br /> Q(d)Drainage <br /> O O 14 CCR§18433-Emergency Response Plan <br /> Q(e)Slope/Grade <br /> Recordkeeping Requirement <br /> Q(f)Siting(New Facilities) <br /> O O 14 CCR§18447-Records Available Q(g)Rim Removal <br /> Q O 1 14 CCR§17351-Fire Prevention Measures Q(h)Protection from Pyrolytic Oil Runoff <br /> Q(a)Communication Equipment Q(c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> Q(b)Fire Equipment <br /> Q(d))Other Requirements Facility Compliance with NFPA�231D-1989 <br /> Comments CR- tImrl.tres+ J em r2Ekec& TrO* 5aiKe_ a4- &G / firW <br /> k &iQ <br /> k�`t� <br /> rD�r -h�.� cu-e r 's�-.�Q as�e,s me. near h <br /> Wo_5e Vx aid. n riAs t be kxu '_ afiej ktd ) A--t --hw d.F- <br /> 11h5oen-r, -two ves weeurla. e_ r_�qYec�irn-►. �lla►v- <br /> ediM 0CCCtrv-�cl Y 0%q�D�Zyi�W" (� h Udu-cles. No V I`o <br /> o��CQ o <br /> 10 7 <br /> INSTRUCTIONS ON BACK Correct: I c JEJXJAJMJPJLJEJ 111213 15386 <br /> ■ White Copy CIWMB Yellow Copy Operator Pink Copy.LEA ® ■ <br /> .ai <br />