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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste TiOurvey and Inspection Repore 304 E WEBER AVE 3"D FL STOCKTON CA 95202-2708 State of California �' F' ".f� (209) 468-3420 CIWMB-54(10/03) rayeA—orl PART A-General Information/Survey i-NINSPEGtOt�d,SCfE rllStT Type(cneckone): 'Routine E] Re-inspection El Complaint El Observation ❑ CIWMB Referral ❑CHP Referral ❑Other. tlnspected b Time In: Dat Regulatory Status: Facility SW1S y Permitted Excluded[I Exempt❑Unpermitted File No. CountylCity `>� ❑ TPID: Q ;Code t1 Hauler ID: ❑State Time Out. To al Time: aortal Status _. _ Acbve❑Closed❑Inactive❑Planned >. r Local: Fire Count:,,; Type: Business/Facility Name: j� ssenger❑Alteredd.Truck❑OTR Storage T t Address: Phone: 2 N tdoor❑Indoor❑Container In O (Please Print): usiness Rep. caner: Title: i v vielw�i Role`of Business:,(ci,eckall that apary) Facili Type'(cneckooe) ;>;. �: °�- .-> ❑ Major WTF(>5,000 tires) E]Minor WTF(>s0o tires) Waste Tire Location (<50o tires) Generator ❑Hauler ElEnd-use Business Type:(check all that'apply) i m fire Dealer ❑Retreader ❑ Dismantler �uto Repair w ❑Auto Body �Caf Dealer ❑Collection ❑Gas Station ❑Trucking Fleet ❑Shredder ❑ Crumb Rubber El Other:Describe T " t Excluded Business Types(check only IrAppucame):', ❑ 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. El14 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 pemrt requirements complete Parts B,C,and D. PART B-Inspection of Waste Tire Dealer, Generator, Hauler and End Use Faciltt V A. C" �`=-'HAULING AND MANIFESTING REQUIRE MENTS �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. ❑ ❑ ❑ 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 NDS WS Permits;Requlr"ements''" [ ❑" ❑ 14 CCR,§j1:7352 ❑ Cl ❑ PRC§42824–Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access - ❑ ❑ ❑ PRC§42834–Minor Waste Tire Facility Permit 11 01 ❑ PRC§42850(a)–Complies with Terms of Permit j, 4dCCR,§17�353'(aecfo ControC E] E] C] 14 CCR§18420(a) –Applicable for Permit ❑ (1)Impermeable Barrier (2) Approved Vector Plan r-.. . .;. �.14�CCR§"17354=Storage'°of Waste,Tires t)utdoo,_ El El 14 CCR§18423 Filing Application for Permit C� 7[ ,4,[ - ;.;,t ❑(a)Storage Units Rk fdkeeping'Requlreinents:`s' ❑ (b)Fire Lanes ❑ ❑ ❑ 14 CCR§18432–Operations Plan ❑ (c)Fire District Requirements ❑ ❑ ❑ 14 CCR§18433–Emergency Response Plan ❑ (d)Drainage ❑ (e)Slope/Grade ❑ ❑ ❑ 14 CCR§18447 Records Available ❑ (f)Siting(New Facilities) % 14 CCR' 17351,"Fire'Prevertion Measures ❑ (g)Rim Removal C [w § ❑ (h)Protection from Pyrolytic Oil Runoff ❑ (a)Communication Equipment ❑ (b)Fire Equipment [ -[ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply Facility compliance with NFPA 231D-1989 ❑ (d)Other Requirements