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ENVIRONMENTAL HEALTH =" SAN JOAQUIN COUNTY .' Waste fire Survey and Inspection Report 304 E WEBER AVE 3"�D FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A—General Information/Survey Page 1 of Z 1NSPFgTION f SITE VISIT Type(Check one) ] Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: t Regulatory Sta s: File No. TPID: J ? El County/City l El Permitted Excluded F] Exempt F1Unpermitted Code: Time Out: Total Time: Op rational Status: Hauler ID ❑State Local: Active❑Closed❑Inactive❑Planned Business/Facility Name: Tire Count: Type: L ❑Passenger❑Altered IdTruck❑ OTR Address: Phone: St rage Type: Outdoor❑Indoor❑Container h Owner: Inspec Please Phnn Business Rep: �y Title: 1 ' CuiCr��_� Facility Type:(Check one) Role of Business:(Check all that apply) ❑ Major WTF(>5 000 crest ❑ Minor WTF,>5cc::res) ❑Waste Tire Location (<500 tires) Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) ❑-Pre Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑Auto Body ❑Car Dealer ❑Collection as Station ❑Trucking Fleet ❑ Shredder ❑Crumb Rubber ❑Other Describe Excluded Business Types(check only if Applicabie): ❑ 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 exduded'*cm permit requirements complete Parts B.C.and D. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End Use Facility Y ''q C HAULING AND MANIFESTING REQUIREMENTS"R ?0,4 ❑ ❑ ❑ I PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ 1 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. ❑ ❑ ❑ 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 I A I C WASTE TIRE STORAGE STANDARDS . . Permits Requirements 1:7 [ [ 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 [ [ [ 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 ❑ F-1 1:114 CCR§ 18447—Records Available EJ (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 Ll (d)Other Requirements Facility compliance with NFPA 231 D-1989