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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY 304 E WEBER AVE 3" FL Waste 'fire Survey and Inspection Report STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) Paof PART A—General Information/Survey Page INSPECTION/SITE VISIT Type(Check one). Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑CIWMB Referral ❑CHP Referral [I Other: Facility SWIS: Inspected by: Time In: Date: Regulatory S�s: File No. TPID: f t<r c�_� E]County/City (� r cf El Permitted Excluded C]Exempt ElUnpermitted Code: Time Out: T tal ime: Operational Status: Hauler ID: ❑State Active E]Closed❑Inactive F-1 Planned Local: Business/Facility Name: Tire Count: Type: 1 �y I U ❑Passenger[]Altered Q ruck❑ OTR Address, / Phone: Storage Type: �' tiY c7Yj 2_ 9butdoor❑ Indoor E3Container Owner: r? Inspec (Please P t): Business Rep: dr me vini. rzZt^yY' N�, , Title: ► l)�v_ L.�,��hp Facility Type:(Check one) Role of Business:(check all that apply) ❑ Major WTF(>5 Doo tires) ❑ Minor WTF(>500 tires) ❑Waste Tire Location (<500 ares) Generator ❑ Hauler ❑ End-use Business Type: (check all that apply) Tire Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑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 Parts B,C.and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility JV1 C HAULING AND MANIFESTING REQUIREMENTS .❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ 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. ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. E]T 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 ❑ ❑ ❑ PRC§42850(a)–Complies with Terms of Permit [ [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§ 18420(a) –Applicable for Permit ❑ (1) Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 –Filing Application for Permit [TE—TE 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑(a)Storage Units ❑ ❑ ❑ 14 CCR§ 18432–Operations Plan ❑ (b)Fire Lanes ❑ (c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433–Emergency Response Plan ❑ (d)Drainage ❑ Ll ❑ 14 CCR§ 18447–Records Available El (e)Slope/Grade El (f)Siting(New Facilities) E ❑ [ 14 CCR§17351 -Fire Prevention Measures El(g)Rim Removal ❑ (a)Communication Equipment El (h)Protection from Pyrolytic Oil Runoff ❑ (b) Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply F1 (d)Other Requirements Facility compliance with NFPA 231 D-1989