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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY N. Wabli.e sire Survey and Inspection Rcp01z 304 E WEBER AVE 3pj� FL STOCKTON CA 95202-2708 State of Califo;is (209) 468-3420 CIWMB-54(10'03) PART A—General Information/Survey Page of INSPEC71ONPITE,VISIT Type(cheat o e` ®.Routine ❑ Re-inspection ❑Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other. Facili -.,Inspected cted b -- Time In: Date Regulatory Status: ty . SVr9S: = pe y: '` 9 rY File NO- -- TP;C: 3 p l }Go6itty/City 1:1 Permitted IR]_Excluded[I Exempt[IUnpermitted � � Code Ha;zr ID: _ ❑State Time Out: T al im _Operatronal.§tatus: fae–❑C ❑I„naa`' ❑Ptanneti LCcz` Bus ness/Facili, Name: Tire Count:.:. Type: t '. passenger❑Altered❑Truck❑OTR Add e�: Phone: =Storage Type t S-Xv � ❑Outdoor®,lndoof❑C&,.". Owner: Inspector(Please Print): lBusiness Rep: ...�.5 Title: Facility Type.'(C+ect one) 'Role of Business:(check all tfui appyj cry ❑ Major�YTF;>=_.cro:res) ❑ Minor WTF(>5oo ores) ®,Waste Tire Location (<500 tires) Z Generator ❑ Hauler ❑End-use Business Type: tct an that oppy) r 4n-Tire Dealer ❑ Retreader ❑Dismantler ❑Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ❑Gas Statior. ❑Trucking Fleet ❑Shredder ❑ Crumb Rubber ❑Other:Describe Excluded Business Types(CheckonylfAppiicabie)t [�14 CCR : '3-20(a)(3)-Facilities storing less than 500 waste tires (Waste Tire Location). ❑ 14 CCR o 13•;20(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises. ❑ 14 CCR 5 'x;20(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days. .R — CCR b 15420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for less than 90 days. If excluded from wri_a—e'e:e Pans B and 0r if not excluded from permt regwreR+ents corrr'ete Parts B.C.and 0. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility ate= ;..-...rREQUIREMENTS- C] 1�' 'A� Cs� :r-�--r-= �•'�':HAULING%1ND MANIFESTING REQUIREMENTS ' .��; .+t'��.>;t+�: '�"•t "��i Y�yr'�+ _ ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. ❑ ❑ ❑ PRC §42953-Contracts with Registered Waste Tire Haulers. ❑ ❑ ❑ ;; CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. ❑ ❑ ❑ ' 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. ❑ ❑ ❑ 14C R§ 18460.2 -Manifest System Requirements for Registered Waste Tire Haulers. ❑ ❑ 1:114 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. C] C] ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C— Inspection of Waste Tire FacilityG. fiID/XRDST. DARD '_Permits Rodirenients'. h cf g 11 �`eR'�1'• 'C. fCX .C '141CCR§;17352;`Site Seciuitjl?' ' ❑ ❑ �❑ 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 :[? `•[ `;E� 14"CCR§17353'.(a'Vedo�i_Cortt_Yoh ' ❑ ❑ ❑ 11 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 06(STMM RecorijKeeping RequTementsi" ` 's ' El (a)Storage Units El El 11 1 4' 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 1:1 (b)Fire Equipment [ [ 1: 14 CCR§17356 =Indoor Storage T'"F E] (c)Water Supply J (d)Other Requirements Facility compliance with NFPA 231D-1989