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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste re Survey and Inspection R Ort 304 E WEBER AVE 3RD FL ••• STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A—General InformationlSurvey Page 4 of i ItJSFECTiONISITEVIS(T - Type(Check one): ❑ Routine Ei-Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑ CHP Referral ❑Other. Ins cted b Time In: Date yT Re ulato Status: Facility SWIS: pe y- 9 rY File No. E5 County/City Q ❑ Permitted ❑ Excluded Exempt❑Unpermitted TPID: C7 a.� '0 Code: �` Hauler ID: - Time Out: T to ime ,_Operational Status:,'----:,,;-.—.,-, I.- ,; -�— ❑State —- �].Achve[]Closed❑Inactive❑Planned ^x Lop1, �;. Business/Facility Name: -fire Count:'. Type. MPassenger❑Altered❑Truck❑OTR �1 Address: Phone: Storage Type:..- 16660. ype e� �Autdo`w❑Indoor❑Container - , Owner: Ins ec t: Business Rep: r Title: Facility Type''(Check ones r Role of Business:(Chick all tai eppbl , ❑Major WTF(>5.000 ores) ❑ Minor WTF(>5oo tires) ®-Waste Tire Location (<500 tires) $Generator ❑Hauler ❑End-use Business Type:(check all nn(apply) R-Tire Dealer ❑Retreader ❑Dismantler ❑ Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ' ❑Gas Station ❑Trucking Fleet ❑Shredder ❑ Crumb Rubber ❑Other:Describe Excluded Business Types(check onty if Apptkabie)c ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(Waste Tire Location). ❑ 14 CCR§18420(a)(4)-Tire retreading facility v.-.:n 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. EL 14 CCR§18420(a)(7)8(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from permit•compiele Pans B and D. If not excluded from per-%:r�u.rornents complete Parts B.C.and 0. PART B—' Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ,: p;G :y.• Y• ,�,,. _ ... _ fir. �. .� ,j - ... .;:'t" ;�":ih ;'f ..V" A• C� LYrn�.t�-_�-'`�_�-._.,. HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ [:]I PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ I 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. ❑ ❑ ❑1 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 ASTi ]IARIMMM_ ST DARD TOO'! Permits Regriirement a?"�°<t_ '�ifi"�J" CS C^ Cu '14,CCR:§17352=Siti..Sec"iuitjr?'� `�9❑ PRC§42824—Major Waste Tire FadLty Permit ❑ (a)Signs ❑(b)Site Attendant ❑(c)Access PRC§42834—Minor Waste Tire Favi ity Permit ❑ PRC§42850(a)—Complies with Terms of Permit '[a [4; .`;.C� 14'CCR§17353'❑ 14 CCR§ 18420(a) —Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§18423 —Filing Application for Permit >[' C* '.•Cs ;14`CCR§17354'=Storage of.Waste Tres Outdoors._, ; -Recoi•dic'eeping Requ�lremenfs ," - -h"n`;'�"`"t El (a)Storage Units E] C] C] 14 CCR§ 18432—Operations Plan El (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'P,revention Measures " ❑ (�Siting(New Facilities) J3' iE_' § ❑ (g)Rim Removal ❑ (a)Communication Equipment ❑ (h)Protection from Pyrolytic Oil Runoff ❑ (b)Fire Equipment [ [ [' 14 CCR§17356 -Indoor Storage El(c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 2310.1989