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k,Nv11xUNMENTAL HEALTH SAN JOAQUIN COUNTY Waste Tir: urvey and Inspection Report 304E WEBER 95202 27 L 08 "' (209) 468-3420 ate of California NMB-54(10/03) Page—or ART A-General Inform adllft ationlSurvey :r gp "0IP �n ll aVIS �- _ Routine a inspection ❑ Complaint C]Observa_on EJ IReferral El CHP Referral El Other: Type(check one): C] Re Regulatory St us: Inspected by: Time In: Dat - 9 rY acility -SWIS:- ❑CountylCiry ❑Permitte xciuded❑Exempt❑ Unpermit3ed ile No. - PID: 'a Code: r Time Out: of Tt e: ,Operational status:."` = State, I ❑Acbve -C -Hauler ❑Inactive.❑Planned .Hauler I - - Local: Tire Count: TY .• 3usiness/Facility Name: assenger❑Altered❑Truck❑ OTR Phone: :Sto ge Type ;'r: address: Outdoor Indoor❑Container 3=� _ 7 rI1 r !mow Business Rep: Own__- Ins actor(Please Print): Title: - b - Rote of Business:(Check all eat appy) _y=�e-•�. Facility Type,'(C11 ons) C] Major WTF I tires) c ❑ Minor WTF(>soo tires) C]Waste Tire Lccat on Generator Hauler El End-use Business Type:(crack as that apph) Retreader [I Dismantler ❑Auto Repair E]Auto Body ❑Car Dealer ❑Collection Tire Dealer ❑ Rubber ❑ Other:Describe .� El Gas Station ❑Trucking Fleet ❑ Shredder ❑ Crumb Excluded Business Types(check ony if Appiidabia): _ i ocz;,on ) ❑ 14 CCR§ 18420(a) (3)- Facilities storing less than 500 waste tires J tes on Premises. E] 14 CCR§ 18420(a)(4) -Tire retreading facility with no more than 3.C7 .as:a ' — ❑ 14 CCR§ 13420(a)(6)-Auto dismantler storing no more than 1,5C3:.as:e t."es for less than 90 days. ❑ 14 CCR§ 18420(a)(7)&(e)-Tire dealer storing no more than 1,5CC-as:e =_s for less than 90 days. t excluded from permt,coal ete Parts 8 and D. If not excluded from permt reQwrernents complete Pa's B.C.and C e Dealer, Generator, Hauler and EdUse�Facii ity PART B — Inspection of Waste Tir r X '_"d,HAULING AND MANIFESTING REQUIREMENTS '- ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC§42953 Contracts with Registered Waste Tire Haulers. ❑ C] E] 14 CCR§ 18459.1 (a) (b)(c)-Tire Program F Number from CIV0,1B E] ❑ C] 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and lire Trip Logs within 90 days. E] ❑ .❑ 14 CCR§ 18459.3 -Retention of Manifest Forms and Tire Trip Logs for 3 years. ❑ El ❑ 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 a Waste Tire Generators. {r PART C-Inspection of Waste Tire Facility D 352SIfe? '_ ecmits•Requl[ements?�'z r' >c -�_ ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access ------------------- ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit ; 4*CCF.§;17353I(a m;��"rcrr_ �A_dr: ❑ ❑ ❑ PRC§42850(a)--Complies with Terms of Permit t I] (1)Impermeable Barrier ❑ (2) Approved Vecto �� ❑ ❑ ❑ 14 CCR§18420(a) –Applicable for Permit ]k4, §:17354'Sforagd'otWastt3Tires Qtit [30 C] 14CCR§18423 –Filing Application for Permit C'` a Storage Units .- ?';';?= `Reeordkeopirig'Recjuliemetti;'° .>: ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§18432–Operations Plan ❑(c)C1(d) ra Fire District Requirements Dinage ❑ ❑ ❑ 14 CCR§ 16433–Emergency Response Plan ❑(e)Slope/Grade ❑ ❑ ❑ 14 CCR§18447–Records Available ❑(f)Siting(New Facilities) 14 CCR§17351;Flre Prevention Measures : ❑(g)Rim Removal [' j❑ �❑ ❑ (h)Protection from Pyrolytic Oil Runoff ommunication El (a)CEquipment -. I [ 14 CCR§17356 .Indoor Storage El (b)Fire Equipment Cc [ I ❑ (c)Water Supply Facility compliance with NFPA 231D-1989 ❑ (d)Other Requirements