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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste I i<rC Survey and Inspection Rep(,. . 304 E WEBER AVE 3' FL i ::9 STOCKTON CA 95202-2708 ;late of California (209) 468-3420 ,IWMB-54(10/03) rage--r�of SART A-General Information/Survey Type(Check one): Routine 7"e-inspection ❑ Complaint ❑ Observation ❑ CIWMB Referral [I CHP Referral [I other ;Inspected by Time In. Da Regulatory Status: =acihty SWIS:y ElExempt❑Unpermitted 6pCountylClty ' ❑Permitted Excluded File No TPID: t IaulerID . a 'C.ode Time Out: T tal Ime: Ope ratldnal,Status � ❑State —_- Active❑Ctosed❑Inat�ive❑Planned _ Local: Tlfe Count .; Type. Business)Facility Name: --�' assenger❑Altered�Truck❑OTR U Y Q 9 yPet Kms, Phon Stora eT +,i s 'g Address: ^2 Outdoor❑f�ldoor.❑Contaq�ery3 ° Ins eCtOr(Please Print): �/ ( / ► ueRep Owner:Own �• Ilry�b�_i IueG.L1 ll.a-T-VI Title: \ N L M l iRoeof Busincantippl) F0C111tYTyP '- } - C3 Maior WTF(>5,000 tires Waste Tire Location (<5oo fres) Generator [I Hauler End-use ❑ Minor WTF(>5oo tires) BUsin@sS_7yp@:(Cf»ckallthatapply).�:' s t w. u? $�?+•� . s�, i'x �. e - .Y.:'-:- Tire Dealer El Retreader El Dismantler LJ Auto Repair El Auto Body []Car Dealer ❑Collection ❑Gas Station El Trucking Fleet ❑ Shredder ❑ Crumb Rubber El Other:Describe , " s , Excluded Business Types(check'onyx4pncame ❑ 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. f 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 m... . • ' 'V A' t- r° HAULING'AND'MANIFESTING REQUIREMENTS. 01 ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transport of Tires. 01 ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CIWMB. bmittal of Manifest Forms and Tire Trip Logs within 90 days. 11 C1 [1 14 CCR§18459.2.1 -Su ❑ ❑ ❑ 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. ❑ 01 ❑ 14 CCR§18462-Manifest System Requirements for Tire Dealers or Waste Tire Generators. PART C-inspection of Waste Tire Facility ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑(a)Signs ❑(b)Site Attendant ❑(c)Access - ❑ ❑ ❑ PRC§42834-Minor Waste Tire Facility Permit 4'•CC-' 535 a. �_. ❑ ❑ ❑ PRC§42850(a)—Complies with Terms of Permit ` roved Vector Plan ❑ ❑ ❑ 14 CCR§18420(a) —Applicable for Permit E] (1)Impermeable Barrier [1 (2) APP 4'CCR ' 73 ❑ ❑ ❑ 14 CCR§18423 —Filing Application for Permit •� d' " Rec'tir"ifkeepinRequl�emetifs •:• � ❑(a)Storage Units ;, ❑(b)Fire Lanes ❑ ❑ ❑ 14 CCR§18432—Operations Plan ❑(c)Fire District Requirements ❑ ❑ ❑ 14 CCR§18433—Emergency Response Plan El❑(e )Slope/Grade d)Drainage C] ❑ ❑ 14 CCR§18447—Records Available ❑(f)Siting(New Facilities) -[t, : I ='14 CCR_§17354";=Jreat?�everifior Mf3astires� ": ❑(g)Rim Removal ❑(h)Protection from Pyrolytic Oil Runoff ❑(a)Communication Equipment [I(b)Fire Equipment �14 CCR 17356,=1nr7oor"Storage [ _C` `C § E] (c)Water Supply Facility compliance with NFPA 231)-1989 ❑ (d)Other Requirements