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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY Waste i'ire Survey and Inspection Repo. 304 E WEBER AVE 3' FL 1--n STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) Pae f of-2, PART A—General Information/Survey p� g L r"� s�.�z2 //ire.., - ✓ s,. ..�'.e .,. ,' <,c'ty..,,,. INSPECT IgN.t3ITEVI , „.x Type(Check one): ARoutine ❑Re-inspection ❑Complaint ❑Observation ❑CIWMB Referral ❑CHP Referral ❑ Other: Facility '-a Inspected by: Time In: Date: Regulatory Sus: File No. T I [ICounty/City � �6 & C1Permitted >atExcluded El Exempt❑ Unpermitted Hauler ID: Code: Time Out: Total Time: Operational Status: ❑State Active❑Closed❑Inactive❑Planned Local: Business/Facility Name: Tire Count: Type: Passenger❑Altered[]Truck❑OTR Address: Phone: Storage Type: �,,�j 52n — Ott - Outdoor❑Indoor❑Container Owner: Inspector(Please Print)' Business Rep: ��r Title: Facility Type:(check one) Role of Business:(check all that apply) ❑ Major WTF(>5,000 tires) ❑Minor WTF(>500 tires) ❑Waste Tire Location (<s o tires) Generator ❑ Hauler ❑ End-use Business Type:(check all that apply) ❑Tire Dealer ❑ Retreader ❑ Dismantler ❑Auto Repair ❑Auto Body 151iCar 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 Parts B,C,and D. PART B— Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility r r ,, r ...>,.., �/ 1/ =A C'';° ,: >--' 00k&MID, REQt1IREMENTS g, rr i r ❑ ❑ ❑ 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. ❑ I ❑ I ❑ 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 V A .0 4.:WASTE TIRE STORAGE STANDARDSf C ,_WASTE TIRE STORAGESTANDARDS Permits Requirements [ [ [ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ 14 CCR§ 18447-Records Available ❑ (e)Slope/Grade El(f)Siting(New Facilities) [ ❑ C: 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 with NFPA 231 D-1989