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k Waste Tire ey & Inspection Rer t SURVEY REQUIRED <br /> !�"g! State of California -� <br /> ���nAAi111 CI InVIB tegrated <br /> steMana4) nspection Form - Page ,2 --- <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile inspection Details <br /> TPID- inspection <br /> Site Suffix: l 7 .Z l l 0 l Report I _ t O �� <br /> Number: <br /> SWIS Inspection Number on the associatedSurvey form(Page 1) <br /> Number: �j / - l , 3 Photos Taken 0 Yes 0 No <br /> Property Owner <br /> vo L <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) <br /> Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facillty Type(Fill one) <br /> �0 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises Major WTF (>5,000 Tires) <br /> 10 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 Minor WTF (500-4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V A I WASTE TIR_E%TORAGE STANDARDS V A <br /> Permit Requirements 0110 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 010 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit O(1)Impermeable Barrier O (2)Approved Vector Plan <br /> 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 /> I <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 <br /> — O (f)Siting(New Facilities) <br /> 0 0 14 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 0 0 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments <br /> aG.��l t"S 1f�t7�N Co ttis <br /> CAWIL <br /> INSTRUCTIONS ON BACK Correct: Incorrect: X ,'�, 11E X A MIP! L E= 111 2N 15386 <br /> -- <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />