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.,, Waste Tire Survey & Inspection Rept EY REQU <br /> SURVIRED <br /> ■ ': State of California <br /> CIWMB182(New 04/04) IC1S ection Form - Pa e 2 <br /> California Integrated Waste Management Board p <br /> Part C- Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection I _ z "1 5 Q w 6 <br /> Site Suffix: 1 � 0 � I � 6 Q Report I S <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes Q No <br /> Property Owner <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 • Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q Excluded Q Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&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)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days 1' Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> V I A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements Q Q 1 14 CCR§17352-Site Security <br /> Q O PRC§42824-Major Waste Tire Facility Permit O (a)Signs O (b)Site Attendant O (c)Access <br /> Q O PRC§42834-Minor Waste Tire Facility Permit O O 14 CCR§17353(a)-Vector Control <br /> Q (1)Impermeable Barrier O (2)Approved Vector Plan <br /> 0 O PRC§42850(a)-Complies with Terms of Permit O O 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q O 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> O O 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> O O 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 (d)Drainage <br /> 0 O 14 CCR§18433-Emergency Response Plan <br /> Q (e)Slope/Grade <br /> Recordkeeping Requirement Q (1)Siting(New Facilities) <br /> O Q 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 0 O 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment Q (c)Water Supply 0 O 14 CCR§17356-Indoor Storage <br /> Q (b)Fire Equipment O (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: ', X A MI P 1 L I E I I Y 1 2 3 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ® ■ <br />