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b.. <br /> Waste Tire Su ey & Inspection Rep <br /> State of California SURVEY REQUIRED <br /> CIWIVIB grated aMeMa age Inspection 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 /> —7 J <br /> Site Suffix: L' 6 LJ - r� ) Report I /f - /1 /f �7 �/ ( J <br /> Number: -F— ..L— .L / 7 <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - Photos Taken Q Yes ® No <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 Q permitted Q Exempt <br /> Excluded Business Types(Fill if applicable) <br /> Q PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) ® Excluded Q Unpermitted <br /> • 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 Q Major WTF (?5,000 Tires) <br /> 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 daysro <br /> 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for 90 days Q Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V 1 A j WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements Q Q 14 CCR§17352-Site Security <br /> Q Q PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant_0 (c)Access <br /> Q Q PRC§42834-Minor Waste Tire Facility Permit Q Q 14 CCR§17353(a)-Vector Control <br /> Q Q PRC§42850(a)-Complies with Terms of Permit _ 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> Q Q 14 CCR§17354-Storage of Waste Tires Outdoors <br /> Q O 14 CCR§18420(a)-Applicable for Permit <br /> 0 (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> Q O 14 CCR§18433-Emergency Response Plan 0 (d)Drainage <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement <br /> 0 (f)Siting(New Facilities) <br /> Q Q 14 CCR§18447-Records Available 0 (g) Rim Removal <br /> Q Q 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0(a)Communication Equipment 0 (c)Water Supply Q Q 14 CCR§17356.Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> L� LG,��ril��y�rC yyl <br /> INSTRUCTIONS ON BACK Correct_ Incorrect: ( �y,� }( � my, p' L Ei 1 15386 <br /> �� ,, <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA ■ <br />