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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste ire Survey and Inspection Re 304 E WEBER AVE 3� FL : STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54 (10/03) PART A—General Information/Survey Page of oL INSPECTION f.SITE.VIStT.... ..� a 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: p E,3 —(.\,_ ®County/City "S U ❑ Permitted ❑ Excluded© Exempt❑ Unpermitted Code: Time Out: T tal ime: Operational Status: Hauler ID: ❑State .Active❑Closed❑Inactive❑Planned Local: Business/Facility Name: Tire Count: Type: w �` C �v• q 83$_353, ti ` 0p ®Passenger❑ d ® ❑ AltereTruck OTR Address: J Phone: Storage Type: „ �$ ¢, ✓� s 2�,_;?10 �❑Outdoor❑ Indoor®Container �N Owner: Inspector(Please Print): Business Rep: L Title:Facility Type:(check one) Role of Business:(check an that apply) ❑ Major WTF(>5,000 tires) ❑ Minor WTF(>sca bres) [jc 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): J4 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 D. If not exclude,from pemdt 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 dpv! ON ❑ ❑ ❑ 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. ❑ ❑ ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C-Inspection of Waste Tire Facility V ` `A i4STE 1RE_S RAGE 57ANDARD`S WAST IRfsS. . ANt1ARD Permits Requirements_''r [ CC" 14 CCR§17352 Site ❑ ❑ ❑ 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(aj 1/ecfor Control �� ❑ ❑ ❑ 14 CCR§ 18420(a) —Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 —Filing Application for Permit 14CCR§17354-Storage of Waste Tires Outdoorsy Recordkeeping Requirements El (a)Storage Units E] ❑ ❑ 14 CCR§ 18432—Operations Plan El (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) [ I ❑; ,[ 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 w th NFPA 231 D-1989