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_ ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waster ire Survey and Inspection Rill 304 E WEBER AVE 3PD FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CI`oVMB-54(10/03) Page L of PART A—General Information/Survey Type(check one): outine ❑ Re-inspection ❑ Complaint ❑ Observation ❑CIWMB Referral ❑ CHP Referral ❑Other: Inspected by: - Time In: Date Regulatory Status: Facility SWIS: county/city � � El Permitted ❑ ExGuded�Exempt❑Unpermitted City File No. TPID: Code: 'j rat 4 : Time Out: Total ime: ,^Operational Status z Hauler ID: ❑StateActive❑Closed❑Inactive❑Planned ,"`:,�?`7F: cr.. ;. Local: Tire Count: Type: Bus• es I Facility Nam ` }Passenger❑Altered❑Truck ElOTR it Phone: Storage Type' Address: td ._ Indoor❑Containeli 7 } b Business Ill (fu Owner: In ector(Please�U C Title: J -2.{J R016 of Business:(check all"tappN) Facility Type:(checkone) Minor WTF(>soo ares) aste Tire Lecatlon (<soo ares) Generator ,Hauler ❑ End use ❑ Major WTF(>5.l tires) ❑ kW Business Type:(check all that apply) .'fire Dealer 171Retreader ❑ Dismantler .�'Ruto Repair ❑Auto Body ❑Car Dealer []Collection Crumb Rubber ❑Other Describe ❑ Gas Station ❑Trucking Fleet ❑ Shredder ❑ ,r Excluded Business Types(check only if Applicable): ❑ 14 CCR§ 18420(a)(3)- Facilities storing less than 500 waste tires(':.a-'"e Tire Location). ❑ 14 CCR§ 18420(a)(4)-Tire retreading facility with no more than 3,C_�•D waste tires on premises. ❑ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 v.=ste tires for less than 90 days. ❑ 14 CCR§ 18420(a)(7) & (e) -Tire dealer storing no more than 1,500 vaste tires for less than 90 days. it excluded from permit,ccmpiete Parts Band D. If not excluded from permit requirements corrple!e Pa-.s B.C.and D. PART B —Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facl It s .,: 'K.a V A C " .� = _HAULING AND MANIFESTING REQUIREMENTS '' ^�^ r'� ❑ ❑ El PRC§42951 (a)-Waste Tire Hauler Registration and Trans;crt 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 Trp 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 am l`;Fermits;Reguilrementsl? �t�`��' ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit - ❑, ❑ i[ 4CCR;§;17353',{aecfoControT£ti'S" ri ❑ ❑ ❑ PRC§42850(a)—Complies with Terms of Permit ; , u,�.,,• roved Vector Plan A LJ (1)Impermeable Barrier (2) Approved ❑ ❑ ❑ 14 CCR§ 18420(a) —Applicable for Permit ❑ ❑ ❑ ❑(a)Stor 14 CCR§ 18423 —Filing Application for Permit [— l=� 'C1 Storage aste Tires 0ufdoojs: '14'CCR§:17354 °oflN ;z age Units r"' Recordkeepirig`F2equireinents ❑(b)Fire Lanes ❑ ❑ -❑ 14 CCR§ 18432—Operations Plan ❑(c)Fire District Requirements ❑ p ❑ 14 CCR§ 18433—Emergency Response Plan ❑(d)Drainage ❑(e)Slope/Grade ❑ ❑ ❑ 14 CCR§18447—Records Available ❑(f)Siting(New Facilities) •14 CCR 17351:',FirePreventlon Measures,.` E](g)Rim Removal ❑_" <C' § ❑(h)Protection from Pyrolytic Oil Runoff ❑ (a)Communication Equipment [I (b)Fire Equipment [ I [[ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply Facility compliance with NFPA 231D-1989 ❑ (d)Other Requirements