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Waste Tire Survey & Inspection Report <br /> State of California � <br /> QUIREDREYR <br /> ClWMB182ie ) <br /> California Integrated Waite Management Board Inspection Form - Page 2 <br /> Part C- Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- ----- -- - --- --- inspection <br /> Site <br /> -- ---- - <br /> Slte Suffix: 1 Q Report I — <br /> Number: '0 ``7 <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: Photos Taken Q Yes ONO <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 O Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded 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 /> 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 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> io 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 /> A WA <br /> Permit Requirements Q Q 14 CCR§17352-Site Security <br /> 0 O FPRC§42824-Major Waste Tire Facility Permit Q (a)Signs O(b)Site Attendant Q (c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit 0 0 14 CCR§17353(a)-Vector Control J <br /> Q PRC§42850(a)-Complies with Terms of Permit O (1)Impermeable Barrier Q (2)Approved Vector Plan <br /> Q ® 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q 0 14 CCR§18420(a)-Applicable for Permit 9 (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> 0 Q 14 CCR§18432-Operations Plan O (c)Fire District Requirements j <br /> O (d)Drainage <br /> Q 14 CCR§18433-Emergency Response Plan <br /> O (e)Slope/Grade <br /> Recordkeeping Requirement Q (t)siting(New Facilities) <br /> O 0 14 CCR§18447-Records Available Q (g)Rim Removal <br /> 00 14 CCR§17351--,Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> Q (a)Communication Equipment 6_(WWater Supply (� 0 14 CCR 117356-Indoor Storage <br /> i <br /> Q(b)Fire Equipment Q (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> /!tc �xo�wt7L G tAOI&Ac.;1�5 9p►l rt*-J-1, WeAVR •-cis <br /> INSTRUCTIONS ON BACK I Correct Incorrect; )( _ ;� !}( hf, p E t ? 3 15386 <br /> _* <br /> . White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />