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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Wastefte Survey and Inspection RefP 304 E WEBER AVE 3RD FL 0: STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54 (10/03) PART A —General Information/Survey Page 1 of �— INSPECTtOt�SITE�VIS1T; Type (check one): ErRoutine ❑ Re -inspection ❑ Complaint ❑ Obserti25on ❑ CIWMB Referral ❑ CHP Referral ❑ Other. Facility File No.: _ : SWIS: ='. �� Inspec�te-d-�b:-�; 10!! 1 ity ,Coder -State Time In: Dat �� Regulatory Status: ❑ Permitted ❑ Excludedij Exempt ❑ Unpermitted TPID: ),z„L k l76 b Hauler ID: (r Time Out. ` o tme na1 ;� ratio Status Acbve ❑Closed ❑ Inactnie ❑ Planned Local:I Business/ Facili.ylLame: Tire Count:". Type: P9 Passenger ❑Altered ❑Truck ❑ OTR Phone: Address: �L 6 4166— � Z�J � Stora e T s `~' g rr YPe [Outdoor ❑Indoor ❑ Container Owner: Ins ector Please Print): o Business Rep: Title: Facility Type: tchea one/ . ;Role of Business: (check all nut_�PPb) ❑ Major WT (>5.ccc t: -es) ❑ Minor WTF (>5oo tires) {Waste Tire Location (moo tires) 'Generator ❑ Hauler ❑ End-use Business Type: tchsck an that aPPb) ' -: ` ® Tire Dealer ❑ Retreader ❑ Dismantler ❑ Auto Repair ❑ Auto Body ❑Car Dealer ❑Collection ❑ Gas Station ❑ Trucking Fleet ❑ Shredder ❑ Crumb Rubber ❑ Other: Describe Excluded Business Types (check only tf bppi(eable)i'r. h.% 1; ❑ 14 CCR § 18420 (a) (3) - Facilities storing less than 500 waste tires (Was:e T i -e Location). ❑ 14 CCR § 18420 (a) (4) - Tire retreading facility with no more than 3,000 vaste tires on premises. ❑ 14 CCR § 18-120 (a) (6) - Auto dismantler storing no more than 1,500 waste tares for less than 90 days. 0- 14 CCR § 18420 (a) (7) 8 (e) - Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from permit, corro'e!e Parts B and D. If not excluded from permit requirements complete Parts B. C. a^d D. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End -Use Facility PART C — Inspection of Waste Tire Facility HAULING AND MANIFESTING REQUIREMENTS�4-:{�ri?:sy==tCfwRxpf# ❑ ❑ ❑ PRC § 42951 (a) - Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC § 42953 - Contracts with Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR § 18459.1 (a) (b) (c) - Tire Program ID Number from CIW'.'3. ❑ ❑ ❑ 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. []1 ❑ ❑ 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 5ARD '� 4f :Permits Requirements'n�`.�:'h `'� G sC'u :C '14CCR §;17352]$Ite';Seciuitjl?�'''4€� a ❑ a 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 [ `.[ 'f4;CCR §17353'(a';VedCoirtiol's►� ❑ ❑ ❑ 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 Qufdoors r" :, "RecordkeepIri§ RequTements 4 u 1 _„ 1 ❑ (a) Storage Units C1 (b) Fire Lanes E] C] C]14 CCR § 18432 - Operations Plan [I(c) Fire District Requirements ❑ 1 ❑ ❑ 14 CCR § 18433 - Emergency Response Plan ❑ (d) Drainage ❑ ❑ E]14 CCR § 18447 - Records Available ❑ (e) Slope/Grade ❑ (0 Siting (New Facilities) ' [ -_0__ ❑ 1[= 14 CCR 17351;= F14F' eV"entlon Measures '' ~ § - ❑ (g) Rim Removal ❑ (a) Communication Equipment ❑ (h) Protection from Pyrolytic Oil Runoff g `� 14 CCR § 17356 `-lridoor Storage; ❑ (b) Fire Equipment [. [ [ ❑ (c) Water Supply ❑ (d) Other Requirements Facility compliance with NFPA 231D-1989