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ENVIRONMENTAL HEALTH s - SAN JOAQUIN COUNTY Waste 'Tire Survey and Inspection Report 304 E WEBER AVE 3P-D FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A- General Information/Survey Page 1 of l— INSPECTION f SITE VISIT Type(chem one) ❑ Routine Re-inspection ❑ Complaint ❑Obse-vation ❑CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date; Regulatory Stal,us: File No. TPID: /l�7 yr —�. ElCounty/City I �, , -> El Permitted W Excluded❑ Exempt❑ Unpermitted Code: Time Out: Total Time: Operational Status: Hauler ID: El State Local Active❑Closed❑Inactive❑ Planned Business/Facility Name: Tire Count: Type: —� EPassenger❑AlteredTruck❑ OTR Address: Phone: Stofage Type: Z�� s7 C), o �t ,g u. c�� ,�3 33 t'Outdoor E]Indoor C]Container Owner: ff Inspector(Please Print): _ Business Rep: N r Gly GA -��, � �<.;��c GT_11 r—vt17t I Title: Facility Type:(check one) Role of Business:(Check an that apply) ❑ Major WTF(-5 000 tires) ❑ Minor WTF(,500 tires) ❑Waste Tire Location (<wo tires) Generator ❑Hauler ❑ End-use Business Type: (Check all that apply) Tire Dealer ❑ Retreader ❑ Dismantler 5fA,,to Repair ❑Auto Body []Car Dealer []Collection ❑ Gas Station ❑ Trucking Fleet ❑ Shredder ❑ Crumb Rubcer ❑ Other: Describe Excluded Business Types(Check only if Applicable): ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(Was:e Tire Location). ❑ 14 CCR § 18420(a) (4)-Tire retreading facility with no more than 3,000.vaste tires on premises. ❑ 14 CCR§ 18420(a)(6)-Auto dismantler storing no more than 1,500 wase tires for less than 90 days. C-1- 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 6 and 0 If not excluded from permit requirements complete Pars E > >^c D. PART B- Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A I C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transpor,of Tires. ❑ ❑ ❑ PRC §42953-Contracts with Registered Waste Tire Haulers ❑ ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from Cfl1`1B. ❑ 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. ❑ EIT ❑F14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C - Inspection of Waste Tire Facility ,1 .;AidrEEJ iNAST RE;S70RACaES DARDS d Y, ,-Aa ,C W/lS[1cnR W ` I 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 ❑ ❑ ❑ 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 231D-1989