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Waste Tire Okey & Inspection R rt <br /> REQUIRED <br /> I{ti�t State of California SURVEY RE Q <br /> CIWMB Waste <br /> eManag) Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> TPID- Inspection `r <br /> Site Suffix: ( , ` -� ' Report <br /> Number: — <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m m Photos Taken 0 Yes 4 No <br /> Name I Mailing Address City State ZIP Code <br /> pe (Fill if applic <br /> O PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O permitted 0 Exempt <br /> Excluded, es,F(l.if. li"ca <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded 0 Unpermitted <br /> O 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast <br /> 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 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 0 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days O 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 -C q§17352-Site Security =0011i <br /> O O PRC§42824-Major Waste Tire Facility Permit 0 (a Signs 0 (b)Site Attendant 0 (c)Access <br /> O O PRC§42834-Minor Waste Tire Facility Permit <br /> O (1)Impermeable Barrier (2)Approved Vector Plan <br /> O PRC§42850(a)-Complies with Terms of Permit <br /> O O 14 CCR§18420(a)-Applicable for Permit 0 (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 /> O O 14 CCR§18433-Emergency Response Plan 0 (d) Drainage <br /> 0 (e)Slope/Grade <br /> 0 (f)Siting(New Facilities) <br /> Q O 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0 (c)Water Supply <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliancewith NFPA 231D-1989 <br /> Comments <br /> AV�-< < <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X i-= JAM L. E � 2 131 15386 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />