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� <br /> Waste Tire Survey & Inspection Report SURVEY REQUIRED <br /> :r:... state orc.womla <br /> crwmete2traewouoa> Inspection Form - Page 2 <br /> Califomla Integrated Wast.Management Board <br /> Part C-Facilit Information BLUE OR BLACK INK PEN <br /> Business-profile Inspection Details <br /> TPID- Inspection —� -- -- - - — <br /> Site Suffix: I I I ! D I I © / I Report I R i - / Q l Q l 2- <br /> Number: - <br /> SWIS Ins ction Number on the associated Survey form(Page 1) <br /> Number: - L I- --j- -I—_�-� Photos Taken Yes No <br /> Property Owner J 1 <br /> e,.T gis N _ Pa9 <br /> ZIP Cuc;& <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 qualities for exemption •Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded O Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water a used for bumpers or ballast• Facility Type(Fill one) . <br /> Q 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 /> Q 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 & 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 STORAGE STANDARDS V A <br /> Permit Requirements Q O 14 CCR§17352-Site Security <br /> O O PRC§42824-Major Waste Tire Facility Permit O(a)Signs O(b)Site Attendant O(c)Access <br /> O O PRC§42834-Mirror Waste Tire Facility Permit O O 14 CCR§17353(a)-Vector Control <br /> O O _PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> O 0 14 CCR§18420(a)-Applicable for Permit O(a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit O(b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> O O 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)SlopetGrade <br /> Recordkee ing Requirement p(f)Siting(New Facilities) <br /> 0 .Q 14 CCR§18447-Records Available O(g)Rim Removal <br /> 01 0 1 14 CCR 117351-Fire Prevention Measures Q(h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments . /I <br /> INSTRUCTIONS ON BACK Corr--CG4 Incorrect: Ah X R P L El 1112131 <br /> 15386 <br /> ■ White Copy CIWMB YelloN Copy Operator Pink Copy.LEA ® . <br /> --J <br />