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r,N v 1KUNME N AL HEALTH SAN JOAQUIN COUNTY Waste Tirt. purvey and Inspection Report 304E 3P-D FL STOCKWEBERON CA 95202 2708 (209) 468-3420 .ate of California IWMB-54(10/03) Page or _ ART A-General Inform ationlSurvey _ g "" "� ItJSP Cf10N 1 SITE iS - M CIWNIB Referral ❑CHP Referral ❑ O her. Routine ARe inspection E] Complaint ❑ Ocsena== ❑ Type(check one): ❑ Regulato Status: Ins ded by:J- Time In: Da` ry acility- SWIS: ❑Permitted�Exciuded E]Exempt❑ Unpermitted a County/City Ile No. TPID: Code: _ Time Out: Total ime: rational Status e �>•:: Hauler ID: ❑State - �gdive❑Ciosed❑Inactive.❑Planned,_ + Local: l Tire Count: Type:' 3usin sl Facility Name: I []Passenger❑Altered❑Truck❑ OTR 6. p ne: _Storage Type Address: = $Outdoor❑(ridoor❑Container; _ . Business Rep: jVLb Ow r: IG�ppct r(Pleas print), Title: Role of Business:(check all ttntapply) Facility Type:(checkone) -WTF(>soo tireserator C1 Hauler C] End-use ) ❑Waste Tire Lcca*or`- =�I C] Major WTF(>5.oco tires) E] Minor Business Type:(ch-k all&at 00y) Auto Repa:r ❑Auto Body ❑Car Dealer ❑Collecticn �e Dealer ❑ Retreader ❑Dismantler ❑ ❑Other:Describe Crump R�.;�=e ❑ Gas Station ❑Trucking Fleet ❑ Shredder ❑ Excluded Business Types(check oniy'lf Applicable): n 14 CCR§ 18420(a)(3)- Facilities storing less than 500 waste tires -s:= a1ion) [] 14 CCR 18420(a) (4)-Tire retreading facility with no more t'nan _:_ :.= t,res on premises. 6 Auto dismantler storing no more than 1,�= 's fo'Icss than 90 days. ❑ 14 CCR§ 14420(a)( )- F ••mss for less than 90 days. 14 CCR§ 18420(a)(7)&(e) -7ire dealer storing no more than 1,..�= %'-�^= - - u ezduCed from perms,corrglete Parts a and D If not excluded Iron perm;requirements ccmp�e'e:z's� _ e Dealer, Generator, Hauler and Ed Usil PART B-Inspection of Waste Tir :�"-HAULING AND MANIFESTING REQUIRcMENTS :..:_ •- ❑ ❑ LJ PRC§42951 (a)-Waste Tire Hauler Registration and Trars-.or,c res. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haule-s ❑ LJ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID er frc- ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trp Lc;s wi hin 90 days. ❑ ❑ ,❑ 14 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip LcYs for 3 years. ❑ ❑ ❑ 14 CCR§18460.2 -Manifest System Requirements for Registeret waste Tire Haulers. ❑ ❑ ❑ 14 CCR§18461 -Manifest System Requirements for Waste Tire End Use Facilities. ❑ ❑ ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers tx Waste Tire Generators. PART C-Inspection of Waste Tire Facility p • �[ ,[ri j[t �14;CCR,§';1235Z�Site'� _ X .Y� r,pecrrtits,Regjulrement3'`�. � ._ _ . ty ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42824-Major Waste Tire Facility Permit — --- ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit 4'CCR§;17353'(a e,o �o'rtrot CEO] ❑ ❑ PRC§42850(a)-Complies with Terms of Permit "' ❑ (1)Impermeable Barrier ❑ (2) ApprovedAVectorn 14 CCR§18420(a) -Applicable for Permit lication for Permit >[4 Es ?14CCR§17354•Sfqg� yy to❑ ❑ ❑ 14 CCR§18423 -Filing App a Storage Units ??� ?' ''Rec`o�dkeepirig'Requl(emenf `yet ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§18432-Operations Plan ❑(c)Fire District Requirements ❑ C] E] 14 (d)Drainage 14 CCR§18433-Emergency Response Plan ❑(e)Slope/Grade ❑ ❑ ❑ 14 CCR§ 18447-Records Available ❑(f)Siting(New Facilities) �' :❑ d[1; '14 CCR,§17351,=;Fire`Preyentio6 Measures ( Rim Removal h)Protection from Pyrolytic Oil Runoff ❑(a)Communication Equipment 14 CCR§17356'-In oor Storage ❑ (b)Fire Equipment 1: C: ' C ❑ (c)Water Supply Facility compliance with NFPA 231D•1989 ❑ (d)Other Requirements