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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste Ire Survey and Inspection Repo. 304 E WEBER AVE 3F`' FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) Pae j of L— PART A—General Information/Survey 9 INSPECTION t SITE VISIT est Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: Inspected by: Time In: Date: Regulatory Statl{s: File No. TPID: UL1 5 CG:J ElCounty/City 44o' �, 4>; _ f❑Permitted Excluded❑ Exempt ElUnpermitted Code: Time Out: ime: O rational Status: Hauler ID: C3State Local: Active❑Closed El Inactive El Planned Business Facility Name: Tire Count: Typ {� Vassenger❑Altered []Truck❑OTR Address: Phone: Stog3ge Type: __7 �5 S - �'h `_ i JG 4 _3 2-` �`lLC1JOutdoor❑ Indoor❑Container Owner: Inspect (Please Print); --, //-- Business Rep: ► ►i -- �fG-i l5 Title: Facility Type:(check one) Role of Business:(check all that apply) ❑ Major WTF(,5.000 tires) ❑ Minor WTF(,500 tires) ❑Waste Tire Location (,500 tires) Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) ❑Tire Dealer ❑ Retreader Cl Dismantler ❑Auto Repair ❑Auto Body Atar 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 8 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 V A I C HAULING AND MANIFESTING REQUIREMENTS /• t ❑ ❑ ❑ 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. ❑ I ❑ ❑ 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 Y A C WASTE TIRE STORAGE STANDARDS,,, , .,, ,;ti, V A C WASTE TIRE STORAGE STANDARDS6. Permits Requirements [ E [ 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 ❑ ❑ ❑ 14 CCR§ 18447—Records Available ❑ (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 E [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 231 D-1 989