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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste fire Survey and Inspection Report 304 E WEBER AVE 3"D FL STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWtd1B-54(10/03) PART A—General Information/Survey Page of 2, INSPECTION If SITE VISIT s . Type(check one) �] Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral ❑CHP Referral ❑Other: Facility SWIS: Inspected by: Time In: Dat Regulatory Staos: File No. TPID: �. � _�� ❑ County/City S' 5 fC-y I ❑ Permitted V Excluded❑Exempt❑Unpermitted Hauler ID: ❑State Code: Time Out: Total Time: O rational Status: Local: Active❑Closed❑ Inactive❑Planned Business/Facility Name: Tire Count: Typ . /\ ' C�� Z 3` _ 12.E assenger❑Altered [_]Truck E] OTR Gcr cs� C v, c, Address: Phone: St ge Type: M,s l t/` Ic1r� C G ��33� t✓J outdoor[kndoor❑Container Owner: IF In pector(Please Print): Business Rep: A� Title: Facility Type:(check one) Role of Business:(check all that apply) ❑ Major WTF(,5,000 tires) ❑ Minor WTF(>50o tires) ❑Waste Tire Location (<50o tires) Generator E) Hauler El 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 excluded from permit.complete Parts B and D If not excluded from permit requirements complete Pars B.C.and D. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A I 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. ❑ ❑ I ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste Tire End-Use Facilities. ❑ ❑ I ❑ 14 CCR§ 18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C— Inspection of Waste Tire Facility Its 7- ,,QR!04 , J�., /STEYIR S[OR/1GE'S A VD!(R Permits Requirements [ [ [ 14 CCR§17352-Site Security ❑ ❑ (:1 PRC§42824—Major Waste Tire Facility Permit [I (a)Signs ❑ (b)Site Attendant EJ(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 ❑ ❑ ❑ 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 ❑ ❑ El14 CCR§ 18447—Records Available [I (e) Slope/Grade El (0 Siting(New Facilities) [ El E: 14 CCR§17351 -Fire Prevention Measures EJ (g)Rim Removal ❑ (a)Communication Equipment E] (h) Protection from Pyrolytic Oil Runoff El (b) Fire Equipment [ [ E: 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply ❑ (d) Other Requirements Facility compliance with NFPA 231 D-1989