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�J <br /> Ji,11Waste Tire Survey & Inspection Repo SURVEY REQUIRED <br /> CIWM rCalitomla Inspection Form - Page 2 <br /> clwwlB taz(raw oaoay + <br /> California Integrated waste Management Board <br /> Part C - Facilli!y Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> — - V111YUUtTL ; ! Inspection , i --moi -- r--r- — —� <br /> v I ^ 0 -7i -7• - d f Report I i '� - I j �']j j <br /> TPID- I i <br /> Site Suffix: -_� + r <br /> I Number: �, � .1__i—_� __ �- �— I � <br /> SW1S Inspection Number on the associated Survey form(Page 1) <br /> Number. I j ` _— _ Photos Taken ® Yes Q No <br /> Property Owner <br /> CX*q)3 -g�-8z , 1°14-rt-f j�J N.,,7 `3 Ac,, ,, G/� 95z ao <br /> . .r i=. - .. r v ,.�. ate^•)'i,�.. .. .ti, /,' <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 Q Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q Excluded ® Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water 8 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 Q Major WTF'(>5,000 Tires) <br /> Q 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> Q 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 I A I WASTE TIRE STORAGE STANDARDS ! V . A i <br /> I Permit Requirements 00 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0(b)Site Attendant O (c)Access <br /> ® Q PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> 0(1)Impermeable Barrier 0(2)Approved Vector Plan <br /> Q Q PRC§42850(a)-Complies with Terms of Permit 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units i <br /> Q Q 14 CCR§18423-Filing Application for Permit 0(b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan 0(c)Fire District Requirements <br /> 0(d)Drainage <br /> Q Q 14 CCR§18433-Emergency Response Pian <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement 0(f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water SupplyQ Q 14 CCR§17356-Indoor Storage <br /> 0(b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231D-1989• <br /> Comments t iol.; -rte {g-G 4z8'3 — ��..?� l a �i�� �r•� �- '— <br /> !-Q � y� +fir �n '� � �s q►"� S'TOrc.�,Q (/'J t��•i v� �1�(7 ��` <br /> - 15386 <br /> INSTRUCTIONS ON BACK Correct:+ Incorrect: IEIXIAIMIPILIEI II 2 3 <br /> White Copy CIWMB Yellow Copy:Operator Pink Copy.LEA <br />