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ENVIRONMENTAL HEALTH -.i - SAN JOAQUIN COUNTY 304 E WEBER AVE 3R' FL Waste "fire Survey and Inspection Report ?..... STOCKTON CA 95202-2708 State of California (209) 468-3420t CIWti1B-54(10/03) PART A-General Information/Survey Page—of ?.'3>INSPECTIOFt/SITE V1SfT _ s*r Type;cre_,,:re) ❑ Routine µ,. Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: 1 Inspected by: Time In: Date: Regulatory Status: File No. ❑County/City o ❑ Permitted Excluded❑ Exempt❑Unperm ttzd TPID 3i, ?�� -o Code: Time Out: Total Time: Operational Status: Hauler ID: ❑State Active❑Closed❑ Inactive❑Planned Local. Business/Facility Name: Tire Count: Type: f ETC aPassenger[]Altered ❑Truck❑ OTR Phone: Storage Type: Address: 1 L Z Outdoor❑Indoor C]Container Owner: I I spe or(Please P ncl: Business Rep: Title:1 5 t� Role of Business:(check all that apply) Facility Type:(checkone) C]Waste Tire Location (<5eo tires) Generator Hauler ❑ End-use ❑ Major INTF i _Cd tuesl E] Minor V� r"(>sco ares) Business Type:(cam all that apply) Tire Dealer ❑ F-1 Retreader ❑ Dismantler Auto Repair El Auto Body ❑Car Dealer ❑Collection E] Gas Station ❑Trucking Fleet C] Shredder ❑ Crumb Rubber ❑ Other: Describe Excluded Business Types(Check only if Apprcable): ❑ 14 CCR§ 18=20(a)(3)-Faclities s'cring less than 500 waste tires(Waste Tire Location). 1-, CCR§ 12^20(a)(4)-Tire retreading facility with no more than 3.000 waste tires on premises 1_� CCR§ 18420(a)(5)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If es^^-cec t :e- a.—_e'a Pace Band D If rct a.:- ed from permit requirements complete Pa.:;B C.and D. PART B- In ection of Waste Tire Dealer, Generator, Hauler and End Use Facility V A C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ PRC§42951 (a)-Waste Tre Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts m:h Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Fors and Tire Trip Logs within 90 days. ❑ ❑ ❑ 14 CCR§ 18459.3 -Retertnon of Manifest Fors and Tire Trip Logs for 3 years. ❑ ❑ ❑ 14C R§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ ❑ 14C R§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ ❑ 14C R§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C-Inspection of Waste Tire Facility w w __..,�.,.�..�...... ••_.. �QRAGE.VAt!tD�E 'µ YYASZB TORAGE�tS�AND Requirements [ [ [ 14 CCR§17352-Site Security ❑ MPermits PRC§42824-Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ PRC§42834-Minor Waste Tire Facility Permit 14 CCR 17353 a -Vector Control ❑ PRC§42850(a)-Complies with Ters of Perit [ [ C §1 Im ermeable Barrier ❑ (2) Approved Vector Plan ❑ 14 CCR§18420(a) -Applicable for Peril ❑ ( ) p14 CCR 17354-Storage of Waste Tires Outdoors 14 CCR§ 18423 -Filing Application for Permit [ [ [ § Recordkeeping Requirements ❑(a)Storage Units ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§18432-Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433-Emergency Response Plan ❑ (d)Drainage ❑ ❑ T(] 14CR§ 18447-Records Available ❑ (e)Slope/Grade (f)Siting(New Facilities) CR§17351 -Fire Prevention Measures ❑ (g)Rim Removal a)Communication ECa•pment ❑ (h) Protection from Pyrolytic Oil Runoff b)Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage c)V laser SupplyFacility compliance with NFPA 231 D-1989 d)0:^•er Requireme"s