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r:N V li-CUNMENTAL HEALTH SAN JOAQUIN COUNTY Waste Tire rveyr and Inspection Report 304E 3RD FL STOCKWEBERON CA 95202-2708 (209) 468-3420 ate of California W MB 51(10/03) Page A— or ART A-General Information/Survey ITE V1S ZRc = ` `i INSPECTION`i: _ ton ❑CIWMB Referral ❑CHP Referral ❑Other. Type(C•''eck one). Routine C] Re-inspection ❑ Complaint ❑ C �-vaRe ulato Sta us: Time In: Dat ' 9 ry acility- -SWIS: Inspected by ❑permitted Excluded❑Exempt❑Unpermitted ounty/City I Ile No. TPID: T:Code- Peracid Time O_:: lot I Ti e. O rational Status r' Hauler ID: El State - ctiv-0 Closed❑Inactive.❑_Planned Local: Tire Count: Type: 3usinessl Facility Name: f4v�ssenger❑Altered❑Truck❑OTR Phon •Sttor�ageType ,,� �.., Y, - address: tdoor❑indoor❑Container _ Business Rep:VLANP,•M M Z j A- pector(Pleas P nt). Title: 0 ner: L Role of Business:.(dheckall thataPPb) ; y - Facility Type"(Check one) - �y,�enerator ❑ Hauler ❑ End-use Minor WTF(>50o ores) ❑Waste Tire __-..auon (c500 tares) �§ ❑ h'=;or WTF(>5.000tires) ❑ ` s7?: Business Type:(check all mat appb) _ Auto Body [ Car Dealer ❑Collection Retreader ❑ Dismantler ❑ Auto -.pair ❑ LThe Dealer ❑ Cru._ Rubber ❑ Other:Describe Gas Station ❑Trucking Fleet ❑ Shredder ❑ 3;t'.r4 Excluded Business Types(check onty tf Applicable): �] CCR§ 18420(a)(3)- Facilities storing less than 500 waste tire_ ':as-Tire Location). [J 14 CCR§ 18420(a)(4)-Tire retreading facility with no more tha-. _ _=,0 =s;e tires on premises. — 4 CCR§ 18420 (a)(6)-Auto dismantler storing no more than 1.5__ =s:� tires for less than 90 days. vaste tires for less than 90 days. 14 CCR§ 18420(a)(7) &(e) -Tire dealer storing no more than 1•=___5 B.c aha o. '.f e.ci,ced from pe"^t•complete Parts Band D. If not excluded from permt requirements cor P;e'.e f Waste Tire Dealer, Generator, Hauler and End-Use Facility PART B- Inspection o r,:•K V A -C? `��`' ""'-r""'�`=•HAULING AND MANIFESTING REQUIFcvMENTS�'+'—.:�•-••— ❑ ❑ 171 PRC§42951 (a)-Waste Tire Hauler Registration and Tra of Tires. ❑ 11 PRC§42953-Contracts with Registered Waste Tire Ha,-'=--s" ❑ ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number f-c CIV�'•!B. ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and T`-e Trip Logs within 90 days. ❑ ❑ -❑ 14 CCR§18459.3 -Retention of Manifest Forms and lire Trip Logs for 3 years. ❑ ❑ ❑ 14 CCR§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ndUse Facilities. C] ❑ ❑ 14 CCR§18461 -Manifest System Requirements for Waste Tire E ❑ ❑ ❑ 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste T-ire Generators. PART C-Inspection of Waste Tire Facility p ents'>�'�'t•'�, :� int �taccR;§';1735Z�stte'�` ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access - :'•�r. ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit R-§4`CC '17353'(a' lectoiCog4rol - Permit i ° 1- ❑ ❑ ❑ PRC§42850(a)-Complies with Terms ofer ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§18420(a) —Applicable for Permit 14 CCR§18423 —Filing Application for Permit - _�?[3 r[s� ?14;CCR.§;'17354';S('0 g�o(WasteTii�es-Outd•_ _ ❑ ❑ ❑ ❑(a)Storage Units `Rec`ordkeeping Requirements:t,'t ❑ (b)Fire Lanes ❑ ❑ ❑ 14 CCR§18,432—Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§18433—Emergency Response Plan ❑(d)Drainage ❑ (e)Slope/Grade CO ❑ ❑ 14 CCR§ 18447—Records Available ❑(f)Siting(New Facilities) Rim Removal C3 ;❑; '14 CCR.§17351,=Flre`Prevention Measures,:: C(9)Protection from Pyrolytic Oil Runoff ❑ (a)Communication Equipment 14 CCR§17356 -Indoor Storage '=z ❑ (b)Fire Equipment C C ❑ (c)Water Supply Facility compliance with NEPA 231D-1989 ❑ (d)Other Requirements