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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> gWaste Tire Survey and Inspection Report 304 E WEBER AVE 3� FL <br /> - STOCKTON CA 95202-2708 <br /> State of California (209) 468-3420 <br /> CIWMB-54(10/03) <br /> PART A -General Information/Survey Page L of <br /> _/ INSPECTION/SITE VISIT <br /> Type(Check one) m Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑ Other: <br /> Facility SWIS: Inspected by: Time In: Date.: Regulatory StatAs: <br /> File No. TPID: ❑County/City L, "')4.-t ❑Permitted W Excluded ❑ Exempt❑ Unpermitted <br /> Code: Time Out: To alTime: 0 tional Status: <br /> Hauler ID: <br /> EI State <br /> Local: & Active -1 Closed❑ Inactive EJ Planned <br /> Business/Facility Name: Tire Count: Type: <br /> I _ A, f"-�.,,.., -,Q <br /> ' Pf;_ ,,L assenger❑Altered ❑Truck❑ OTR <br /> (moi�- <br /> Address: ` Phone: Storage Type: <br /> �C,7.,--g 7J -�� _7�c ^ cJ���� Q/Outdoor❑ Indoor❑Container <br /> Ownjr: Inspecctto�r(Please Print): Business Rep: <br /> C) I�r.-, ��- 1'•� Title: <br /> Facilitytype:(Check one) Role of Business:(Check all that apply) <br /> ❑ Major WTF(>5,000 tires) ElMinor WTF(>500 tires) ❑Waste Tire Location (<5oo press [,29Generator ❑ Hauler ❑ End-use <br /> Business Type:(check all that apply) <br /> ❑Tire Dealer ❑ Retreader ❑ Dismantler Auto Repair ❑Auto Body ❑Car Dealer ❑Collection <br /> ❑ Gas Station ❑Trucking Fleet ❑ Shredder ❑ Crumb Rubber ❑ Other Describe <br /> Excluded Business Types(check only if Applicable): <br /> ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(Waste Tire Location). <br /> ❑ 14 CCR§ 18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises <br /> ❑ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. <br /> J 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days <br /> If excluded from permit,complete Parts B and D If not excluded from permit requirements complete Parts B.C a-a D. <br /> PART B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility <br /> V A I C I HAULING AND MANIFESTING REQUIREMENTS <br /> ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires <br /> ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. <br /> ❑ ❑ 14 CCR§ 18459.1 (a) (b)(c)-Tire Program ID Number from CIWMB <br /> ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. <br /> ❑ ❑ ❑ 14 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. <br /> ❑ ❑ ❑ 14 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. <br /> ❑ ❑ ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. <br /> ❑ ❑ ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. <br /> PART C—Inspection of Waste Tire Facility <br /> "^WASTE TiREwSTORAGE STANDARD ,,; <br /> 1/ -4-i ;C WASTE�iVgSTOR 4GE$ DARD <br /> Permits Requirenrl [ [ 14 CCR 6 17352-Site Security <br /> ❑ ❑ ❑ PRC§42824-Major <br /> (2 0 9) 2 3 9-5 3 09 � >ite Attendant El (c)Access <br /> El El El PRC§42834-Minot <br /> El <br /> §42850(a)-Col Vector Control <br /> ❑ E] E] 14 CCR§ 18420(a) Barrier ❑ (2) Approved Vector Plan <br /> ❑ ❑ ❑ 14 CCR§ 18423 -F orage of Waste Tires Outdoors <br /> Recordkeeping Req ALL AROUND TIRE & BRAKE <br /> Q ❑ ❑ 14 CCR§ 18432-0 FULL SERVICE AUTO REPAIRS <br /> quirements <br /> ❑ ❑ ❑ 14 CCR§ 18433-El <br /> ❑ ❑ ❑ 14 CCR§ 18447-R 2072 W. Yosemite <br /> =ilities) <br /> [ F1 [ 14 CCR§17351 -Fit Fax(209)824-8544 Manteca, CA 95337 <br /> ❑ (a)Communicatio i Pyrolytic Oil Runoff <br /> ❑ (b)Fire Equipment [ I [ I [ 14 CCR§17356 -Indoor Storage <br /> ❑ (c)Water Supply <br /> El (d)Other Requirements Facility compliance with NFPA 231 D-1989 <br />