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Waste Tire Ivey & Inspection Re, rt SURVEY REQUIRE ■ <br /> ■ :::ii7: State of California <br /> CIWMedWast(Now Mana e) Inspection Form - Page 2 <br /> Cali Integrated Waste Management Board <br /> Part C- Facility Information _ BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> ` Inspection <br /> Site Suffix: 1 `Q m ® 1 Report <br /> Number: <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: m m Photos Taken 0 Yes 0 No <br /> Property Owner - <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 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 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 CC R§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 da Minor WTF (500-4,999 Tires) <br /> Part D- Inspection of Waste Tire Facility <br /> VAWASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 0 0 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 1 O (a)Signs O (b)Site Attendant O (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§17353(a)-Vector Control <br /> (1)Impermeable Barrier O (2)Approved Vector Pian <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 0 0 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit O (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan O (c)Fire District Requirements <br /> 0 0 14 CCR§18433-Emergency Response Plan O (d)Drainage <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement O (f)Siting(New Facilities) <br /> 0 _9414 CCR§18447-Records Available O (g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O (c)Water Supply 010 14 CCR§17356-Indoor Storage <br /> ta(b)-Fire Equipment --O-(d)-Other-Requirement --Facility-Compliance with NFPA231D--1989 <br /> Comments <br /> Aions <br /> (bs <br /> INSTRUCTIONS ON BACK Correct: Incorrect: %� N) E A Jl4 F 112 3 <br /> 15386 <br /> ® White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />