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iIa <br /> Waste Tire O&y & Inspection Re SURVEY REQUIRED <br /> CState of California �+ <br /> CIWMB 182(New 04/04) Inspection Form - Page e 2 <br /> California Integrated Waste Management Board p g <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> - - �_ r r Inspection <br /> Site Suffix: � - ' � � '� I � i Number: <br /> Site Report � I f l r <br /> � I ) / <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken 0 Yes Q No <br /> Name Phone Number Mailing Address City State ZIP Code i <br /> 'OP RC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption O permitted Q Exempt <br /> O 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&used for bumpers or ballast <br /> O 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 /> O 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 VSA <br /> Q' Q 1 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 I O PRC§42850(a)-Complies with Terms of Permit 0 (1) Impermeable Barrier (2)Approved Vector Plan <br /> O O 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 01 0 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> CCR§ 1 <br /> Q 0 14 Operations Plan 0 (c)Fire District Requirements <br /> 84 2 3 - <br /> Q O 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> 0 (f)Siting(New Facilities) <br /> 0 O 114 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 Compliance with NFPA 231 D-1989 <br /> Comment <br /> 1 <br /> - 4-1 ` <br /> INSTRUCTIONS ON BACK Correct:* Incorrect: X i X' A M r I- I- i .31 15386 <br /> White Copy:CIWMB Yellow Copy.Operator Pink Copy:LEA <br />