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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste Wire Survey and Inspection Report 304 E WEBER AVE 3RD FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWNIB-54(10/03) PART A-General Information/Survey Page_of a- s- - INSPECTION[SITE VISIT,-, Type(check one) ❑ Routine Re-inspection ❑ Complaint ❑ Obser.,ation ❑ CWJMB Referral [I CHP Referral ❑ Other: Facility SWIS: Inspected by: TimeIn: 5-T—e: e: Regulatory Ste s: File No. TPID J3I 9Z $-� ❑County/City � Q E] Permitted Excluded❑ Exempt❑ Unpermitted Code: Time Out: Op rational Status: Hauler ID: E] State Active El Closed❑ Inactive❑ Planned Local: Business/Facility Name: Tire Count: Ty —�' I � [ Passenger[]Altered []Truck❑ OTR —U+"i erre� � I►-� Address: Phone: St��oyy��ge Type:/ O_i Z� ZC� ❑Outdot;�Indoor❑Container Owner,. i I v �, ins ec or(Please Pent): Business Rep: Title: Jit II CV-1:5,i-� Facilityype:(Check one) Role of Business:(Check all that apply) ❑ Major WTF(>5 oco tires) ❑ Minor WTF(>5oo tires) ❑Waste Tire Location (<5co::res) Generator ❑ Hauler ❑ End-use Business Type:(Check all that apply) ire Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ❑ Gas Station ❑ Trucking Fleet ❑ Shredder ❑ Crumb Rubber ❑ Other: Describe Excluded Business Types(check only if Applicable): ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(Waste Tire Location). ❑ 14 CCR§ 18420(a) (4)-Tire retreading facility with no more than 3,000 waste tires on premises. ❑ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. Q" 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from permit,complete Pans 8 and D If not exci-Ced from permit regwremenes complete Parts 8 C and D. PART B - Inspection of Waste Tire Dealer, Generator, Hauler and End Use Facility JV1 C' HAULING AND MANIFESTING REQUIREMENTSPRC§42951 (a)-Waste Tire Hauler Registration and Transpor,of Tires PRC §42953-Contracts with 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 Forms and Tire Trip Logs within 90 days. ❑ 14 CCR§ 18459.3 •Retention of Manifest Forms and Tire Trip Logs for 3 years. ❑ 14 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators PART C - Inspection of Waste Tire Facility WA$TE5�1RE:$'IOR¢GE;STANDARDS FI 0 G D Permits Requirements [ [ [ 14 CCR§17352-Site Security ❑ ❑ ❑ PRC§42824-Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)-Complies with Terms of Permit [ [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§ 18420(a) -Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 -Filing Application for Permit [ [ [ 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑(a)Storage Units ❑(b)Fire Lanes 07101 ❑ ❑ 14 CCR§18432-Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433-Emergency Response Plan ❑ (d)Drainage ❑ ❑ ❑ 14 CCR§ 18447-Records Available ❑ (e)Slope/Grade ❑ (f)Siting(New Facilities) [ ❑ [ 14 CCR§17351 -Fire Prevention Measures ❑ (g) Rim Removal ❑ (a)Communication Equipment ❑ (h) Protection from Pyrolytic Oil Runoff ❑ (b) Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d) Other Requirements Facility compliance with NFPA 231D-1989