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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste fire Survey and Inspection Report 304 E WEBER AVE 3RD FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A-General Information/Survey Page_of Z INSPECTION 7 SITE VISIT ) Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑Observation ❑CIWMB Referral ❑ CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date: Regulatory Sta s: File No. TPID: j -.J_� ❑County/City ElPermitted Excluded F1Exempt(:1Unpermitted Hauler ID: Code: Time Out: Total Time: O rational Status: El State Local: Active❑Closed ElInactive ElPlanned Business/Facility Name: Tire Count: Typ3r L-� E)Passenger[]Altered❑Truck❑ OTR Address: Phone: ---, S�tto��B8eType: ti L /-I' j 4—. h ¢ cn 7_35. Eldutdoor❑ Indoor❑Container Owner: Inspector Please Pnnt" Business Rep: acs Title: - nc > ✓'*� Facility Type:(Check one) 0 Role Z Business:(Check all that apply) ❑ Major WTF(,5,000 tires) ❑ Minor WTF(>500 tires) ❑Waste Tire Location 1,500 tires) QGenerator ❑ Hauler ❑ End-use Busi ss Type:(Check all that apply) ©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 if Applicable): ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires N'Jaste 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. 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 Parts B and D If not excluded from permit requirements complete Pa-s B C a-d D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A C HAULING AND MANIFESTING REQUIREMENTS t ❑ ❑ ❑ 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 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. ❑ ❑ ❑ j 14 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ ❑ 1 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C- Inspection of Waste Tire Facility 41,1 RAO' UfAGj STANDARS, , ... fi :V ,A C5x ., AS.T.T �f�RAGESTANDARDS.,, 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 ❑I ❑ ❑ 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 ❑ ❑ ❑ 14 CCR§ 18432—Operations Plan ❑(b)Fire Lanes ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433—Emergency Response Plan ❑(d)Drainage ❑ ❑ ❑ 14 CCR§ 18447—Records Available ❑(e)Slope/Grade [ ❑ [ 14 CCR§17351 -Fire Prevention Measures [I(❑(g Siting(New Facilities) 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