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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste tire Survey and Inspection Report 304 E WEBER AVE 3' FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A—General Information/Survey Page I of�-- �..n .:<. INSPECTION/SITE VISITS Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: Inspected by: Time In: Date• Regulatory Status: File No. TPID: 17--7 3`5-r-$— f ❑County/City j S'�� ❑ Permitted ]'Excluded❑ Exempt❑Unpermitted Code: Hauler ID: State Time Out: Total Time: Qperational Status: ❑ Local: Active❑Closed❑Inactive❑ Planned Business/Facility Name: Tire Count: Ty e: 4Passenger❑Altered []Truck❑ OTR Address: Phone: Storage Type: 6 '4'c: Outdoor❑Indoor El Container Owner: InspeG��i ere Pr n): 1� Business Rep: I�xS Title: �. �'V l?r S Ui-- Facility Type:(check one) Role of Bus Hess:(Check all that apply) ❑ Major WTF(,5.000 tires) ❑ Minor WTF(,500 tires) ❑Waste Tire Location (,500 tires) 5d Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) ❑Tire Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑Auto BodyI 'Car Dealer ❑Collection El Gas Station ❑Trucking Fleet [I Shredder El Crumb Rubber F1 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 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 A I C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ 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 V A C WASTE TIRE STORAGE STANDARDS V A C WASTE TIRE STORAGE STANDARDS 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 [:1 (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) E ❑ [ 14 CCR§17351 -Fire Prevention Measures ❑ (g) Rim Removal ❑ (a)Communication Equipment ❑ (h) Protection from Pyrolytic Oil Runoff ❑ (b)Fire Equipment I [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply El (d)Other Requirements Facility compliance with NFPA 231 D-1989