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ZIN V I KUNMENTAL rif, A I TH SAN JOAQUIN COUNTY Waste Tire rvey and Inspection Report 304ETWEBER ON CA VE 3:D FL STOC08 (209) 468-3420 ate of California Page or `NMB-54(10/03) ART A-General Information/Survey s INSPECTjON` IT-ElVISIT = TST :K.. Type check one): Routine ❑ Re-inspection ❑ Complaint ❑ Observz='on �CIWMB ulato Referral CHP HP Referal 11 Other yp ( Time In: Date: Reg ry _ --'Ins by:"7- i exempt❑Unpermitted acility.. SWIS. , ermitted ❑Excluded[ ile No. - _ County/City �- TPID: Code: Time Out: Total e: Operational Status , =. ' Hauler ID: ❑State _ ❑Active Q Closed❑Inactive❑Planned.A . 3 ,�:� _ Local: Tire Cotint: Type: 3usinessi Facility Name: �assenger❑Altered❑T ick C1 07R ^ :Storage Type Phone: - Ad ress: n 1 C �..,�V Outdoor$ Iridoor❑Container_ In ector(Please Print): Business Rep: NL Ow er. C Title: Rote of Business:(cheat apply) --`:3=�e•�... Facility Type:(check one) ❑Generator End-use Minor WTF(>soo ores) l C] Waste Tire Location (<soo tires/ ` ia.,`er ❑ C] Major WTF(>s.coo tires) ❑ Business Type:(Check an that spvb) Auto Bod ❑Car De '=_r Collec- ti Retreader ❑Dismantler ❑ Auto Repair ❑ Y Q Tire Dealer ❑ Crumb Rubber 'Other:Describe ❑ Gas Station C1 Trucking Fleet ❑Shredder ❑ Excluded Business Types(Check onyifApplicable):` ' (] 14 CCR§ 13420(a)(3)- Facilities storing les s than 500 vraste tires(`'yas:e Tire Location). — (] 14 CCR§ 18420(a)(4) Tire retreading facility with no more than 3.000 vraste tires on premises. — ❑ 14 CCR§ ore than 1,500 vras:= tires for less than 90 days. 13420 (a) (6)-Auto dismantler storing no m ❑ 14 CCR§ t 8420(a)(7)8(e) -Tire dealer storing no more than 1,500 was,.e tires for less than 90 days. u eio,ded from permit,cc Tviete Parts B and D. if not e■cluded from permit requirements corr;:e'e Pans B.C.and D. PART B —Inspection of Waste Tire Dealer, Generator, Hauler and End-Use ; =r , r ;HAULIN V AC' G-AND MANIFESTING REQUIREMENTS +-- -€ k ❑ C] ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. ❑ -Tire Program ID Number from ClVl,'-lB. ❑ [j 14 CCR§ 18459.1 (a)(b)(c) ❑ ❑ ❑ 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 D ; ❑ :E ([# 14;CCR M22S[fer . - =91" :pan Hi Requlreipent��r r�" ❑ ❑ ❑ PRC§42824—Maio(Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant C](c)Access - ?^F;r•? ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit 4TCC ,§;17353 a�;�_ec Corot 11 ❑ PRC§42850(a)—Complies with Terms of Permit r ' 1mpermeable Barrier ❑ (2) APProvedVettior Plan ' ❑ ❑ ❑ 14 CCR§ 18420(a) —Applicable for Permit - a�-• � t14CCR§:17354•;sfor"�g'"r!_'o_tWasteTires:'outd.. _ ❑ ❑ ❑ 14 CCR§18423 —Filing Application for Permit 'C-:� rC• - 1,,,•, . >;-) ❑(a)Storage Units Rec6 dkeepirig Requlremenfs �: ' :. >'. ❑(b)Fire Lanes C] ❑. ❑ 14 CCR§ 18432—Operations Plan ❑(c)Fire District Requirements ❑ C] C1(d)Drainage❑ 14 CCR§18433—Emergency Response Plan ❑(e)Slope/Grade ❑ ❑ ❑ 14 CCR§ 18447—Records Available ❑(f)Siting(New Facilities) ❑(g)Rim Removal ❑'. ❑; '14 CCR§17351,=Flre'Pceverition Measures;: ❑ (h)Protection from Pyrolytic Oil Runoff ❑ F (a)Communication Equipment 14 CCR§17356 -Indoor Storage ❑ (b)Fire Equipment [ ❑ (c) Nater Supply Facility compliance with NFPA 231 D-1939 ❑ (d)Other Requirements