Form MO780-1715 "Scrap Tire Collection Center Inspection Checklist - Solid Waste Management Program" - Missouri

What Is Form MO780-1715?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form MO780-1715 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-1715 "Scrap Tire Collection Center Inspection Checklist - Solid Waste Management Program" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
SOLID WASTE MANAGEMENT PROGRAM
SCRAP TIRE COLLECTION CENTER INSPECTION CHECKLIST
I. GENERAL INFORMATION
BUSINESS NAME
REGION
OWNER/MANAGER/EMPLOYEE
TELEPHONE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP
COUNTY
MO
NUMBER OF SCRAP TIRES ON SITE AND LOCATION
II. INSPECTION QUESTIONS: Check All Sections – C = Compliant, V = Violation or NA = Not Applicable/Evaluated/Observed
FIRE PROTECTION 10 CSR 80-8.020(4)(A)
INSIDE STORAGE
OUTSIDE STORAGE
OTHER STORAGE
C
V
NA
☐ ☐ ☐
1.
SCRAP TIRE STORAGE COMPLIES WITH LOCAL FIRE CODES
OR IN COMPLIANCE WITH 2006 IFC
☐ ☐ ☐
1.
SCRAP TIRES STACKED SEPARATELY AND ARRANGED IN ORDERLY PILES
☐ ☐ ☐
EMERGENCY VEHICLE ACCESS AND FIRE LANES
2.
☐ ☐ ☐
3.
DISTANCE TO STRUCTURES AND LOT LINES AT LEAST 50 FEET
☐ ☐ ☐
WEEDS, GRASS, COMBUSTIBLES CONTROLLED WITHIN 40 FEET OF THE STORAGE AREA
4.
☐ ☐ ☐
5.
PUBLIC ACCESS LIMITED
☐ ☐ ☐
6.
ACCESS FOR FIREFIGHTING EQUIPMENT
LOCATION 10 CSR 80-8.020(4)(B)
C
V
NA
☐ ☐ ☐
COLLECTION CENTER NOT LOCATED IN WETLAND, SINKHOLE OR FLOODPLAIN
VECTOR CONTROL 10 CSR 80-8.020(4)(C)
C
V
NA
SCRAP TIRES DRAINED OF WATER AND KEPT DRY WITHIN BUILDING, ENCLOSED TRAILER OR UNDER
☐ ☐ ☐
IMPERMEABLE COVER
OR
☐ ☐ ☐
SCRAP TIRES ALTERED AND DO NOT CONTAIN WATER
OR
☐ ☐ ☐
LARVICIDE/ADULTICIDE APPLIED CORRECTLY
OR
☐ ☐ ☐
ALTERNATIVE METHOD OF VECTOR CONTROL APPROVED BY THE DEPARTMENT
RECORDKEEPING REQUIREMENTS 10 CSR 80-8.0020(5)
C
V
NA
☐ ☐ ☐
MONTHLY SUMMARY TRACKING FORM MAINTAINED (OR OTHER FORM APPROVED BY THE DEPARTMENT)
☐ ☐ ☐
RECORDS OF VECTOR CONTROL ACTIVITIES MAINTAINED
☐ ☐ ☐
RECORDS MAINTAINED FOR THE LAST THREE YEARS
☐ ☐ ☐
RECORDS AVAILABLE FOR INSPECTION UPON REQUEST
☐ ☐ ☐
SCRAP TIRES LAWFULLY REMOVED BY EMPLOYEES
☐ ☐ ☐
SCRAP TIRES REMOVED BY PERMITTED SCRAP TIRE HAULER
NUMBER OF SCRAP TIRES GENERATED EACH MONTH:
MO 780-1715 (01-18)
Page 1 of 2
MISSOURI DEPARTMENT OF NATURAL RESOURCES
SOLID WASTE MANAGEMENT PROGRAM
SCRAP TIRE COLLECTION CENTER INSPECTION CHECKLIST
I. GENERAL INFORMATION
BUSINESS NAME
REGION
OWNER/MANAGER/EMPLOYEE
TELEPHONE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP
COUNTY
MO
NUMBER OF SCRAP TIRES ON SITE AND LOCATION
II. INSPECTION QUESTIONS: Check All Sections – C = Compliant, V = Violation or NA = Not Applicable/Evaluated/Observed
FIRE PROTECTION 10 CSR 80-8.020(4)(A)
INSIDE STORAGE
OUTSIDE STORAGE
OTHER STORAGE
C
V
NA
☐ ☐ ☐
1.
SCRAP TIRE STORAGE COMPLIES WITH LOCAL FIRE CODES
OR IN COMPLIANCE WITH 2006 IFC
☐ ☐ ☐
1.
SCRAP TIRES STACKED SEPARATELY AND ARRANGED IN ORDERLY PILES
☐ ☐ ☐
EMERGENCY VEHICLE ACCESS AND FIRE LANES
2.
☐ ☐ ☐
3.
DISTANCE TO STRUCTURES AND LOT LINES AT LEAST 50 FEET
☐ ☐ ☐
WEEDS, GRASS, COMBUSTIBLES CONTROLLED WITHIN 40 FEET OF THE STORAGE AREA
4.
☐ ☐ ☐
5.
PUBLIC ACCESS LIMITED
☐ ☐ ☐
6.
ACCESS FOR FIREFIGHTING EQUIPMENT
LOCATION 10 CSR 80-8.020(4)(B)
C
V
NA
☐ ☐ ☐
COLLECTION CENTER NOT LOCATED IN WETLAND, SINKHOLE OR FLOODPLAIN
VECTOR CONTROL 10 CSR 80-8.020(4)(C)
C
V
NA
SCRAP TIRES DRAINED OF WATER AND KEPT DRY WITHIN BUILDING, ENCLOSED TRAILER OR UNDER
☐ ☐ ☐
IMPERMEABLE COVER
OR
☐ ☐ ☐
SCRAP TIRES ALTERED AND DO NOT CONTAIN WATER
OR
☐ ☐ ☐
LARVICIDE/ADULTICIDE APPLIED CORRECTLY
OR
☐ ☐ ☐
ALTERNATIVE METHOD OF VECTOR CONTROL APPROVED BY THE DEPARTMENT
RECORDKEEPING REQUIREMENTS 10 CSR 80-8.0020(5)
C
V
NA
☐ ☐ ☐
MONTHLY SUMMARY TRACKING FORM MAINTAINED (OR OTHER FORM APPROVED BY THE DEPARTMENT)
☐ ☐ ☐
RECORDS OF VECTOR CONTROL ACTIVITIES MAINTAINED
☐ ☐ ☐
RECORDS MAINTAINED FOR THE LAST THREE YEARS
☐ ☐ ☐
RECORDS AVAILABLE FOR INSPECTION UPON REQUEST
☐ ☐ ☐
SCRAP TIRES LAWFULLY REMOVED BY EMPLOYEES
☐ ☐ ☐
SCRAP TIRES REMOVED BY PERMITTED SCRAP TIRE HAULER
NUMBER OF SCRAP TIRES GENERATED EACH MONTH:
MO 780-1715 (01-18)
Page 1 of 2
III.
NAME AND PERMIT NUMBER OF SCRAP TIRE HAULER(S)
IV. FINAL DESTINATION OF REMOVED SCRAP TIRES
V. COMMENTS/RECOMMENDATIONS
SIGNATURE OF INSPECTOR
DATE
MO 780-1715 (01-18)
Page 2 of 2
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