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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste Wire Survey and Inspection Report 304 E WEBER AVE 3' FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) 1 PART A-General Information/Survey Page_of INSPECTION t SITE VISIT Type(Check one): Routine ❑ Re-inspection ❑ Complaint ❑Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: Inspected by: Time In: Dat: Regulatory Statu File No. TPID: , _ ❑ County/City j5` fit.f ElPermitted xcluded❑Exempt❑Unpermitted Code: Time Out: Total Time: O rational Status: Hauler ID: C3 State � Local: Motive❑Closed❑Inactive❑Planned Business/Facility Name: Tire Count: Typ� C"rte_ OPassenger[]Altered ruck[I OTR Address: Phone?-- S�tto�pj�ge Type: C� — 5'7 j -�� ,��v {— F� �c� / r-2 333 "Outdoor ElIndoor[I Container Owner: Insp ctor(Please PPrint): Business Rep: Title: Facility Type:(Check one) Rolle 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 as that apply) VTire 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 I'excluded from permit,complete Pa-s B 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' AC HAULING AND MANIFESTING REQUIREMENTS r ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 `;. � .� wAs, s .. -.- wa"stirow`csA i» Q ANDARDS 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) —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 ❑ 01 ❑ 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 [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 231 D-1989