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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste "fire Survey and Inspection Report 304 E WEBER AVE 3' "" STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A— General Information/Survey Page 1,of INSPECTION I SITE VISIT Type(check one) ❑ Routine Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑ Other: Facility SWIS: Inspected by: Time In: Date: Regulatory Status: File No. TPID 3l,<J ]�-_S -C ❑ County/City C t 4 O El Permitted Excluded E] Exempt ElUnpermitted Hauler ID: Code:E] State Time Out: To aI Time: Operational Status: Local P Active❑Closed❑ Inactive❑Planned Business/Facility Name: f_ Tire Count: Ty e: C, C'�r) Passenger❑Altered ❑Truck❑ OTR Address: Phone: Storage Type: /C I ) �S UJ,, L,xi -,` —Z0 Outdoor❑ Indoor❑Container Owner: I spe or(Please P incl: Business Rep: cit^►�'� -�� 6.k;us Title: , �t > -`�r,✓�' Facility Type:(Check one) Role of Business:(check all that apply) ❑ Major WTF fo0o tires) ❑ Minor WTF(1500 tires) ❑Waste Tire Location (<500 tires) Generator Hauler ❑ End-use Business Type:(check all that apply) 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 exc ded from pe-.,a cc—p'.ete Parts B and D If not excluded from permit requirements complete Pa-s B C.and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A C HAULING AND MANIFESTING REQUIREMENTS ❑ X ❑ 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 CNVMB. ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Trip Logs within 90 days. ❑ I ❑ ❑ 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 Y.: A %C WASTE2RE�STQRAGE STANDARDS-x JJr goililil WAST_ R RAG TANDARDS' Permits Requirements [ [ [ 14 CCR§97352-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 [ [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§18420(a) -Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ 01 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 ❑ (d)Drainage rE] i 14 CCR§ 18447-Records Available ❑ (e)Slope/Grade 14 CCR§17351 -Fire Prevention Measures E)( Siting(New Facilities) El (gg)Rim Removal (a)Communication Equipment [I (h)Protection from Pyrolytic Oil Runoff (b)Fire Equipment [ E: [ 14 CCR§17356 -Indoor Storage (c)Water Supply ❑ (d)Other Requirements Facility compliance with NFPA 231 D-1989