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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY `x� Waste i ire 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_of INSPECTION I SITE VISIT i Type(cneckone) Routine ❑ Re-inspection ❑ Complaint ❑ Observation [I CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date: Regulatory Stat File No. TPID: Z p _�, ❑County/City S ❑ Permitted Excluded ❑Exempt❑ Unpermitted Code: Time Out: TotalTime: Operational Status: Hauler ID: F]State p Local: [fictive E3 Closed El Inactive El Planned Business/Facility Name: Tire Count: Typ / 2 assenger❑Altered ❑Truck❑ OTR Address: Phone: Storage Type:/ 1�63_4q_tC7 ❑Outdoor Indoor Container Owner: Inspector(Please Pr. ):n Business Rep: Title: � ec Facility Type:(Check one) Role pf BusineS :(Check all that apply) ❑ Major WTF(>s coo tires) ❑ Minor WTF(>soo tires) ❑Waste Tire Location (<sco tires) Generator ❑ Hauler ❑ End-use Bus' ess Type:(check all that apply) El Tire 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. If excluded from,permit,complete Parts B and D If not excluded from permit requirements compie!e Parts B.C.and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A 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. ❑ 56 ❑ 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. ❑ &rl ❑ 1 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C— Inspection of Waste Tire Facility rAl ,. _. ASTETIRE,StORAGE_STANDARDS ��€ A :.,' R 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 [ I [ I [ 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 ETC [ 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑ (a)Storage Units foc 14 CCR§ 18432—Operations Plan El (b)Fire Lanes El (c)Fire District Requirements 14 CCR§ 18433—Emergency Response Plan ❑ (d)Drainage ❑ 14 CCR§ 18447—Records Available ❑ (e)Slope/Grade El (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