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ENVIRONMENTAL HEALTH $= SAN JOAQUIN COUNTY Waste Tire Survey and Inspection Report 304 E WEBER AVE 3' FL ,.... STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A—General Information/Survey Page of �. INSPECTION!SITE VISIT Type(Check one) [9/Routine ❑Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date• , Regulatory States: File No. ❑County/City h L� ❑ Permitted U Excluded❑ Exempt❑ Unpermitted TPID: 1 74, 5 —v f Code: Hauler ID: Time Out: T al ime: Op rational Status: ❑State &Active❑Closed❑Inactive❑ Planned Local: Business/Facility Name: Tire Count: Type: r C r Passenger❑Altered❑Truck❑ OTR L+O Address: Phone: Upout Type: 1 — -� � ^ ��'� Outdoor[I Indoor❑Container Owner: QQ I spec Please Pnntli BUSlness Rep: �� Title: C'� Role f Business:(Check all that apply) Facility Type:(check one) F1 Major WTF(>5 000 tires) F1 Minor WTF(>500 tires) ❑Waste Tire Location (<500 tires) Generator Hauler El End-use Business Type:(Check all that apply) El Tire Dealer ❑ Retreader ❑ Dismantler Auto Repair E:1 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(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. 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 Par's B C and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Fac ility, IHAULINGAND MANIFESTING REQUIREMENTS RC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. RC§42953-Contracts with Registered Waste Tire Haulers. 4 CCR§ 18459.1 (a)(b) (c)-Tire Program ID Number from CIWMB4 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. 4 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. 4 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. 4 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 V A C WASTE TIRE STORAGE STANDARDS V A C WASTE TIRE STORAGE STANDARDS 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 ❑ El ElPRC§42850(a)—Complies with Terms of Permit [:TC: [ 14 CCR§17353(a)-Vector Control ❑ El ❑ 14 CCR§ 18420(a) —Applicable for Permit E] (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 ❑ (b)Fire Lanes ❑ ❑ ❑ 14 CCR§ 18432—Operations Plan ❑ (c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433—Emergency Response Plan ❑ (d)Drainage ❑ ❑ ❑ 14 CCR§ 18447—Records Available ❑ (e)Slope/Grade ❑ (f)Siting(New Facilities) ❑ [ 14 CCR§17351 -Fire Prevention Measures ❑ (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 231 D-1989