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Waste Tire Survey & Inspection Report <br /> CIWMState f182(Nmla - Page <br /> CIWMedWaitew04/04) <br /> anage Inspection Form g <br /> California Integrated Waite Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> (Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: r'�1 J Report I <br /> ` Number: O <br /> SWIS lnspectron Number on the associated Survey farm(Page 1) <br /> Number: Photos Taken Q Yes e No <br /> Property Owner <br /> 54; k4,,..CA 95 <br /> i Exempt Business Type (Fill if applicable) I Permitted Regulatory Status (Fill one) 1 <br /> Q PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption Q Permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) Q Excluded Q Unpermitted <br /> Q 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill ane) <br /> Q 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises Q 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 1AiA�'f TIRE&fQRAEiE-13TANDA4RQS- V- A <br /> I Permit Requirements 010 1 14 CCR§17352-Site Security _ <br /> Q Q PRC§42824-Major Waste Tire Facility PermitO (a)Signs O (b)Site Attendant Q (c)Access <br /> Q Q 14C CR§17353(a)-Vector Control <br /> • Q PRC§42834-Minor Waste Tire Facility Permit I - - - - <br /> Q(1)Impermeable Barrier O (2)Approved Vector Plan <br /> 01 Q PRC§42850(a)-Complies with Terms of Permit - - " <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit Q (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit O (b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan O(c)Fire District Requirements <br /> O(d)Drainage <br /> Q Q 14 CCR§18433-Emergency Response Plan <br /> _ � _ I Q (e)Slope/Grade <br /> Recordkeeping Requirement p (f)Siting(New Facilities) <br /> Q Q !. 14 CCR§18447-Records Available O (g)Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures O (h)Protection from Pyrolytic Oil Runoff <br /> O(a)Communication Equipment O(c)Water SupplyQ Q 14 CCR§17356-indoor Storage <br /> O (b)Fire Equipment O (d)Other Requirements I Facility Compliance with NFPA 231D-1989 <br /> Comments T/�C <br /> Cli lr r �'-►�---t f` G %1 vac. G�e����rs ~�ir'ti✓`�. Vin �e— <br /> l 411r,__3 of t-e- ^t 4v CJ crc- a ria.j,r - <br /> v�-�y-f� <br /> ©r <br /> INSTRUCTIONS ON BACK 1 l _ I: r� µ p l I 1 2 3 15386 <br /> _ - _' <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />