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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste fire Survey and Inspection Report 304 E WEBER AVE 3RD FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A-General Information/Survey Page_of 2— INSPECTION „ INSPECTION t SITE VISIT g ` "iii` Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑ CHP Referral ❑Other: Facility SWIS: i Inspected by: Time In: Date: Regulatory Stat s: File No. TPID: Zt}t; G-z�j_ij ❑County/City s �eI �� ❑ Permitted Excluded E] Exempt EJUnpermitted Hauler ID: Code: Time Out: T al'rime: Op tional Status: ❑State Local: Active ElClosed ElInactive❑Planned Business/Facility Name: Tire Count: Ty..pee- iassenger❑Altered ❑Truck❑ OTR Address: Phone: y St9hige Type: Outdoor❑ Indoor❑Container Owner: Insp/e�tor(Please Print): Business Rep: (X';r"h�% c t Title: s .& �+n Facility Type:(Check one) Role of Business:(Check all that apply) ❑ Major WTF(,5.000 tires) ❑ Minor WTF __ ❑Waste Tire Location (,500 tires)) Generator ❑ Hauler ❑ End-use Business Type:(Check all that apply) Tire Dealer ❑ Retreader ❑ D s rantler ❑Auto Repair ❑Auto Body ❑Car Dealer []Collection ❑ Gas Station ❑Trucking Fleet ❑ SI-edder ❑ 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 fat y with no more than 3,000 waste tires on premises. ❑ 14 CCR§ 18420(a)(6)-Auto dismantler s:c,ing no more than 1,500 waste tires for less than 90 days. 14 CCR§ 18420(a)(7)&(e)-Tire dealer s'.--,ng no more than 1,500 waste tires for less than 90 days. If excluded from permit,complete Parts Band D. re., .,emenls cc—plete Pars B.C,and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A I C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953-Contracts with Reg:s:ered 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. ❑ Q ❑ 14 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. ❑ ❑ ❑ j 14 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ ❑ 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 Y ; A Cry o „ QRAGFnSTANDARD$ *V!C: Permits Requirements [ [ 14 CCR§17352-Site Security ❑ ❑ ❑ PRC§42824–Major Waste Tire Facility Permit ❑(a)Signs El (b)Site Attendant ❑(c)Access ❑ El PRC§42834–Minor Waste Tire Facility Permit ❑ ❑ I ❑ I PRC§42850(a)–Complies with Terms of Permit [ [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ 01 14 CCR§18420(a) –Applicable for Permit ❑ (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 ❑ ❑ ❑ 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 [ El E: 14 ( 14 CCR§17351 -Fire Prevention Measures El (g Siting(New Facilities) g)Rim Removal ❑ (a)Communication Equipment ❑ (h) Protection from Pyrolytic Oil Runoff ❑ (b)Fire Equipmenf [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 231 D-1989