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Waste Tire S & Inspection Report � X003 <br /> Survey pSUR E EQUIR D <br /> State of Celltomla <br /> CIWMa 182(Now g4104) Inspection Form - Page.2 <br /> CelHornla Integrated Waste Management Board <br /> Part C-Facility Information BLUE OR BLACK INK PEN <br /> �S!- <br /> siness Profile Inspection Details <br /> 1 -+7 --` -- - -t I I Inspection -i- /� I-- -`�- , —7 r--1 1I <br /> teTPIsuffix: 1,`=-I �/I !�� ���I © �J Report I I 1 <br /> DJ.t _._j. Number: ISWIS Inspection Number on the associated Survey form(Psge.1) <br /> 1.. i--I <br /> Number: � _...1 I Photos Taken 6Ye5 Q No <br /> Property Owner J- <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) I®Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water a used for bumpers or ballast Facility Type(Fill ane) <br /> 0 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste fires on premises 0 Major WTF (>_5,000 Tires) <br /> 0 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)S(e)-Tire dueler storing no mare than 1,500 waste Urns fa 90 days B Minor WTF (500.4,999 Tires) <br /> Part D-Inspection of Waste Tire Facility <br /> V 1 A I WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 070 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit O(a)Signs O(b)Site Attendant O(c)Access <br /> ® 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> O(1)Impermeable Barrier O(2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0(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 1 0 1 14 CCR§18433-Emergency Response Plan O(d)Drainage <br /> O(e)SlopelGrade <br /> Recordkeeping Requirement 0(f)Siting(New Facilities) <br /> 0101 14 CCR§18447-Records Available O(g)Rim Removal <br /> 0101 14 CCR§17351-Fire Prevention Measures O(h)Protection from PyrolyUc Oil Runoff <br /> O(a)Communication Equipment O(c)Water Supply 010 1 14 CCR§17356-Indoor Storage <br /> O(b)Fire Equipment O(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> ��✓�-�iv� — _/LG Gf7���v�-- �i��v- 1..��g� ire,. <br /> x 4 x 1-2-a 3 <br /> L04!- <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct:l] Incorrect:?& (E x a M P E 3 1 2 ■ <br /> ■ White Copy.CIWMB Yellow Copy.Operator Pink Copy LEA _ <br />