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ENVIRONMENTAL HEALTH .: SAN JOAQUIN COUNTY n R Wastt e Survey and Inspectio .irt 304 E WEBER AVE 3RDFL 0: STOCKTON CA 95202- 2708 State of California (209) 468-3420 CIWMB-54(10/03) PARTA—General Information/Survey PageOf _ 1—INFIRUSAN ON .INSEECTION fSITEI%1SIT, Type(Chem one; ®Routine ❑Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑ CHP Referral ❑Other. Ins cte b Time In: Da `` Re ulato Status: Facility SWIS: pe Y 9 rY File No. TpID: / u /City ,�� ❑Permitted ❑ Excluded Eq,,Exempt❑Unpermitted I�Dde Time Out: ota ime —;Operational Status:< Hauler ID: ❑State 2 '' -- Local: ( Pcbve �Closed❑Inactive❑Planned Business/Facility Name: Tire Count:.: Type: JBPassenger❑Altered❑Truck❑OTR Address: Phone: Storage Type $l0 7 $autdoor❑Indoor❑Container Owner: YInSDector Please Print): JBusiness Rep: 1 o Title: Facility Type'(meek one) of Business:_(chock�ll that appbj r" ❑ Major W7F(>5.0oo tires) ❑ Minor WT (>soo tires) Waste Tire Location (<500 tires) (�-Generator ❑ Hauler ❑ End-use Business Type:(ci,.ckannni2'ppNl moire Dealer ❑Retreader ❑Dismantler ❑Auto Repair ❑Auto Body [--]Car Dealer ❑Collection , ❑Gas Station ❑Trucking Fleet ❑Shredder ❑ Crumb Rubber ❑Other: Describe Excluded Business Types(check only tf Applicable): ❑ 14 CCR § 1 8420(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 o 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 perp,hrrplele Parts 8 and D. tf not excluded from permit requirements complete Parts B.C.and D. PART B - Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility `A :C r+` .±�^-;�-!'ti"":HAULING AND MANIFESTING REQUIREMENTS-!- ' F 7 ;�= == >~4t�=� jr ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ FRC§42953-Contracts with Registered Waste Tire Haulers. JS ❑ ❑ '4 CCR§18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ 4 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 ' Q _ ST . DARn Vis es , _Permits Requirements'�r��.Et ?•..��ir. ": "` 'R'i�" TC' aC`x ❑ `14CCR§17352'=Site;Securitjr?�126 _ Iq ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)—Complies with Terms of Permit - ❑ ❑ ❑ 14 CCR§18420(a) —Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§18423 —Filing Application for Permit ' `[ [ 14`CCR§:17354 Storago of,Waste:Tres Outdo*._ Y''� �_ ❑ (b)Fire Lanes "• Recordkeeping Requj cements_t_" a"` r '4'' (a)Storage Units E] ❑I C] 14 CCR§18432—Operations Plan E�-(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§18433—Emergency Response Plan ❑ (d)Drainage ❑ ❑ ❑ 14 CCR§18447—Records Available ❑ (e)Slope/Grade '��,,, El (f)Siting(New Facilities) [;' 11j[. 14 CCR§17351-Fire�Preventfon Measures„``;;_.,;"; ❑ (g)Rim Removal ❑ (a)Communication Equipment ❑ (h)Protection from Pyrolytic Oil Runoff ❑(b)Fire Equipment [ [ [ 14 CCR§17356 Indoor Storage `t^ ❑ (c)Water Supply EJ (d)Other Requirements Facility compliance with NFPA 231D-1989