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;-2. <br /> _,_ Waste Tire S*ey & Inspection Rept SURVEY REQUIRED <br /> State of California <br /> m;ia CIWMedWast(New anage 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: ' 1 �J l Report I 4 - J-.;,) 1- C Q_ <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - - Photos Taken 0 Yes 0 No <br /> Property Owner <br /> ci-4 Al- taw.� 0FZ AcaifFo CA Ci.5 Xac <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 • 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)(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 storingno more than 1,500 waste tires for 90 days <br /> ® Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> VI A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 00 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 /> 00 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 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0 0 1 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply 00 14 CCR§17356-Indoor Storage <br /> 0(b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> CL) � , --,�,,-t- 'T-),-'4 GGA 'This -+►vim <br /> WLvl c3 ; yl c-k— comp _- Nlri l3L =R e eo r'YICeyl f" GL1 ,tet <br /> AI�-I-2t.4 Q9 C-71%�p 4 110-71 -7 6 <br /> �t3 f�f L��� -9'��c'�_ 1�1,t�t.v��'.�' ��,r .�i-,�rn c ��2.�'��►�G Jr..C�,®tt:��}�� �-� <br /> '�1r,C?S�, UJf'. t WGcJ�'.. •"}��f`�-S �,Z�� �� �D � - <br /> INSTRUCTIONS ON BACK [Clorrect. Incorrect: E A p 112 3 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />