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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY . Waste fire Survey and Inspection Report 304 E WEBER AVE 3P-D FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) 1 PART A-General Information/Survey Page of ',7— INSPECTION I SITE VISIT �` "�� .;: ,,., ..,:, � �zx_ r. > a>, Type(Check one) ❑ Routine Re-inspection ❑Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date: Regulatory Sta s: File No. TPID O l'Z. -- ❑County/City t� ?Jr, C E] Permitted El Excluded❑Exempt❑Unpermitted Code: Hauler ID: [I State Time Out: T tal Time: O rational Status: Local: Active El Closed❑ Inactive E] Planned Business/Facility Name: Tire Count: TyP� —�" f c) [Passenger❑Altered❑Truck❑ OTR Address: t Phone: S�topage Type: a urndoor❑Container F` ve Z ' Owner-. -5,10 � Ins eclor(please Print): Business Rep: 7._L, l� Title: Jt1 hz) Facilitytype:(Check one) Role of Business:(check all that apply) ❑ Major WTF(>5 000 tires) ❑ Minor WTF(>500 tires) ❑Waste Tire Location (<500 tires) ❑Generator ❑ Hauler ❑ End-use Business Type: (check au that apply) ire 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 5 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 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. ❑ 9 ❑ 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 WIA ` R ; ORAESIANDARDS TT@fF COMf ,YAETy AND Ft y y Permits Requirements [ [ [ 14 CCR§17352-Site Security ❑ ❑ ❑ PRC§42824-Major Waste Tire Facility Permit El (a)Signs El (b)Site Attendant ❑(c)Access ❑ ❑ ❑ PRC§42834–Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)–Complies with Terms of Permit C C E: 14 CCR§17353(a)-Vector Control E] E] E] 14 CCR§ 18420(a) –Applicable for Permit ❑ (1)Impermeable Barrier El (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§18423 –Filing Application for Permit [ [ [ 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑(a)Storage Units ❑ ❑ ❑ 14 CCR§ 18432–Operations Plan ❑ (b)Fire Lanes ❑ (c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433–Emergency Response Plan El (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 ❑ (b)Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 231 D-1989