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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste -tire Survey and Inspection Rep 1" 304 E WEBER AVE 3p"' FL Kim: STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PARTA—General Information/Survey Page of INSPEC7lOt�,,�,3,�TE�•,_ - Type(check one): Routine ❑ Re-inspection ❑Complaint ❑Observation ❑CIWMB Referral ❑CHP Referral ❑ Other: Facility" SWIS t .�, ' _ �: :`Inspected by:"' Time In: Dat : Regulatory Status: un /Ci r ❑ Permitted AR Excluded xe Unpermitted Fite No.", �-O�ety `ty .. b' ❑State Time Out: 'tot;fl Time: -Operational Local: Active❑Clased❑`Inactive;❑Planned Business/Facility Name: Tk.te Count:_ Type: \ - \ A01 S�Ib –316ti-S {�O EPassenger❑Altered®Truck❑ OTR Address: Phone: Storage Type: '❑Outdoor a Indoor❑Contatner>P Owner: �T jnspector Please Print): Business Rep: Title: . Facility Type_`(cnack o Rote of Business:'(c heck an encaPPb1 -. ❑ Major WTF(-5,000 tires) ❑Minor WTF(>500 ares) Waste Tire Location (<soo fires) 19 Generator ❑Hauler ❑ End-use BUSII835 Type:(Check all that a PPhrt 7 ,<,- ; ,� �: � '`. moire Dealer ElRetreader El Dismantler , ❑Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ❑Gas Station ❑Trucking Fleet ❑Shredder ❑Crumb Rubber ❑Other. Describe Excluded Business Types(check'onyrraplkzble):` y ' 8 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 Pans 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 f'v A 1C (. _ 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. ❑ ❑ j] 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 - GpNDARD. f'.x .: sj r;Permits'RR§17352'^SIte:S 70� ❑ PRC§42824-Major Waste Tire Facility Permit Signs ❑(b)Site Attendant ❑(c)Access ❑ ❑ PRC§42834-Minor Waste Tire Facility Permitr 4`CCR 17353 a e o Control'❑ ❑ PRC§42850(a)-Complies with Terms of Permit [ .. § ( ._ ; ❑ ❑ ❑ 14 CCR§18420(a) -Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan x• a z14CCR 17354 Storagemof Waste Tires;Outd . ❑ ❑ ❑ 14 CCR§ 18423 -Filing Application for Permit [� -[4 [ - -... § eteeoeeplrid_R6q_—UWt"tlentss: :'� E] (a)Storage Units fdk t ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§ 18432-Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433-Emergency Response Plan ❑(d)Drainage ❑ ❑ ❑ 14 CCR§ 18447–Records Available ❑ (e)Slope/Grade x El(f)Siting(New Facilities) [�'; ;❑- {❑?A4 CCR§17351=Fire'Pceventfori Measures ❑(g)Rim Removal ❑(a)Communication Equipment ❑(h)Protection from Pyrolytic Oil Runoff ❑(b)Fire Equipment [ [ [' '14 CCR§17356 -Indoor Storage ❑(c)Water Supply El (d)Other Requirements Facility compliance with NFPA 2310-1989