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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste 'fire Survey and Inspection Re 304 E WEBER AVE 3RD FL State of California STOCKTON CA 95202-2708 CIWMB-54(10/03) (209) 468-3420 PART A—General Information/Survey Page_�_of 3 1NSR�CTIO��S�3 . Type(Check one): [a}Routine ❑ Re-inspection ❑Complaint ❑ Observation ❑CIWMB Referral ❑CHP Referral ❑Other. Facility ! Inspected by dimeln [)a( Keguiatory5tatus: File No. I TPID. 13( �fl 5\ – 0\ ®County/City �� ❑Permitted ❑ Excluded®-Exempt❑Unpermitted Hauler ID:. Code Time Out: Total Time. ;Operation_al Status:: . rx ,. fi .. ❑State - - - .. �,�2` ��.:��,•. Local: - Active❑Closed❑Inactive❑Plactned; Business/Facility Name: [,2o�i) Tire Count:_ Type: V –�ic.�or� passenger❑Altered[]Truck❑OTR Address: <X1.25 Phone: =Storage�rpe outdo ❑I ❑Container/ - Owner: \, 1 (pspector(Please Print): Business Rep: �� f�ovJcl1sKt � c� �as�a�...�is Title: I Facility Type::(ctoekone) , RoleofBusiness:(chackantnatappy) „�.. s . I ❑Major WTF(>5.000 tires) ❑ Minor WTF(>500 tires) ®Waste Tire Location (<500 fires) o[ Generator B Hauler ❑ End-use Business Type:(Chock all that apply) t x ❑Tire Dealer ❑ Retreader ❑ Dismantler ®-Auto Repair ❑Auto Body ❑Car Dealer ❑Collection ❑Gas Station ❑Trucking Fleet ❑ Shredder ❑Crumb Rubber ❑ Other.Describe _.. Excluded Business Types check on `lr "' YP ( N ApPllcable);` — - — , Via` " ® 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 0. If not excluded from perntit requirements complete Parts B,C.and 0. PART B—Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility HAULINGAND MANIFESTING REQUIREMENTS " s '* ❑ ❑ ❑ 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. ❑ ❑ 0 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 ? "P&Mitsr`.emerits' �, d7 f-4 1" 14;CCR§17352=Site.Sl [� ❑ ❑ ❑ 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 CR§17353'(aJ=`We-cf rjoI'r- . ❑ ❑ ❑ 14 CCR§ 18420(a) –Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 –Filing Application for Permit torage ot.Wai to Tires t)utdoo � , ` .Recordkeepirig'"Req'ti�tremenfs„��.� � � , „ x :"T�: ❑(a)Storage Units ❑ ❑ ❑ 14 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 v ._ s ❑(f)Siting(New Facilities) `,Q ) 14 CCR§17351;,FGe'Preyerition Mea'suress7,.: . ,., C1(g)Rim Removal [I(a)Communication Equipment ❑(h)Protection from Pyrolytic Oil Runoff ❑ (b)Fire Equipment I [ I [ ` [ '14 CCR§17356 -Indoor Storage c.s [:1 (c)Water Supply ' a��t�tE El (d)Other Requirements — Facility compliance with NFPA 231D-1989