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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste Tire Survey and Inspection Report 304 E WEBER AVE 3"" FL LON STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) Page t of PART A-General Information/Survey .. aa � `� 'INSPECTIONrS_TE ,VISR_ T;10 50 - Type(check one): ❑ Routine ❑ Re-inspection ❑ Complaint ❑ Observation : CIWMB Referral ❑ CHP Referral ❑Other: Facility SWIS: Inspec;tad by: Time In: Date' Regulatory Stat�a File No. f County/City ' j ( ElPermitted EJExcluded❑ Exempt E]Unpermitted TPID: A'6'{fir _> Hauler ID: State: Time Out: Total T me: Oppr'ational Status:, x Active El Closed[IInactive❑Planned Local Business/ ac'lity Name: Tire Count: Type: , ❑Passenger E2/Altered OTruck OTR Address: Phone: Stor e Type: Outdoor❑ Indoor 0 Container Owner: In eCtOf(Please rn�q,:� Business_ Rep: ~✓vl� `� �f C �'-f tom!r� Title: Facility Type:(check ones Rolle of Bust ess: check all that aP 4 ) ❑ Major WTF(>s 000 tires) ❑ Minor WTF(>500 tires) ❑ Waste Tire Location (<500 tires) Generator Mauler ❑ End-use Rusin 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. ❑ 4 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 perrrit,complete Parts 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 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. ❑ ❑ ❑ 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. ❑ ❑ ❑ 1 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C-Inspection of Waste Tire Facility YVAST"9E3 5,STANDARD` A'. 'G BASTE TIt2E S tORAGe4e bARD3 Permits Requirements = C C E:' 14 CCR§17352-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 El El El14 CCR§ 18423 —Filing Application for Permit [ 14 CCR§17354-Storage of Waste Tires Outdoors Y Recordkeeping Requirements >•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 ❑ (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 [ [ [ 1 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply El (d)Other Requirements Facility compliance with NFPA 231D-1989