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Waste Tire Survey and Inspection Report State of California CIWMB-54 (10/03) PART A — General Information/Survey ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY 3 0 4 E WEBER AVE 3RD FL STOCKTON CA 95202-2708 (209) 468-3420 Page L of*y INSPECTION ! SITE VISIT Type (check one) Routine ❑ Re -inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑ CHP Referral ❑ Other: Facility File No. SWIS: Inspected by: TP ID: ElCounty/City 2v-----� Code: Hauler ID: ❑ State Local: Time In: Date: G _ Lt_ L. Regulatory Sta s: ❑ Permitted tZ Excluded E]Exempt ElUnpermitted Time Out: Total Time: Operational Status: Active ❑Closed E] Inactive ❑Planned Business/ Facility Name: Tire Count: __L1 c5 Type: `I��ypassenger ❑Altered []Truck ❑ OTR Address: Phone: V ��`_ _ -2['1 7^ Storage Type/ Outdoor ®Indoor E] Container Owner: fAA ] iI11 Inspector (Please Pnn : Business Rep: Title: Facility Type: (check one Role of Business: (Check all that apply) ❑ Major WTF (>5 000 tires) ❑ Minor WTF >soc tves) ❑ Waste Tire Location (<500 Gres) 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 exck.ded from permit. complete Parts B and D. If not exc:_dea from permit require—a, prm , o, - -u ...__._ T:__ 11-1-1— -1 Fnrl-I Ica Pne-ility -- V A C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ I PRC § 42951 (a) - Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ 1 PRC § 42953 - Contracts with Registered Waste Tire Haulers. ❑El [ [ [ ❑ 1 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 - Retent.on 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. ❑ ❑ (1) Impermeable Barrier ❑ (2) Approved Vector Plan ❑ 14 CCR § 18462 - Manifest System Requirements for Tire Dealers or Waste Tire Generators. oADr r I.,cr or+inn r%f VVacta Tirn Farilitv V A C - WASTE TIRE STORAGE STANDARDS V A C WASTE TIRE STORAGE STANDARD .. , __ 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) - Appl!cable 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 ❑ (b) Fire Lanes ❑ (c) Fire District Requirements ❑ (d) Drainage El (e) Slope/Grade El (f) Siting (New Facilities) El(g) Rim Removal ❑ (h) Protection from Pyrolytic Oil Runoff E]❑ ❑ 14 CCR § 18432 - Operations Plan ❑ ❑ ❑ 14 CCR § 18433 - Emergency Response Plan ❑ ❑ ❑ 14 CCR § 18447 - Records Available E: EJ[ 14 CCR § 17351 - Fire Prevention Measures El(a) Communication Equipment ❑ (b) Fire Equipment ❑ (c) Water Supply ❑ (d) Other Requirements [ [ [ 14 CCR § 17356 - Indoor Storage Facility compliance with NFPA 231 D-1989