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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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1900 - Hazardous Materials Program
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PR0520338
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
11/22/2024 2:29:50 PM
Creation date
6/10/2018 11:33:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0520338
PE
1921
FACILITY_ID
FA0006672
FACILITY_NAME
FLYING J TRAVEL PLAZA #618*
STREET_NUMBER
1501
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22811017
CURRENT_STATUS
01
SITE_LOCATION
1501 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
FilePath
\MIGRATIONS\J\JACK TONE\1501\PR0520338\COMPLIANCE INFO .PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
11/5/2015 10:27:50 PM
QuestysRecordID
2918794
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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0 Pre-Inspection 0 <br /> Health and Safety Assessment <br /> Facility Name: Flying Js FAM 0006672 <br /> Location: 1501 N Jack Tone Rd, Ripon, Ca PR#: 0520338 <br /> Business Type: Truck Stop <br /> Initially Completed W Nick I_oehrer Date: 8/17/2015 <br /> Instructions: Fill out this form as best as possible before the initial inspection and complete the remaining information during or after <br /> the inspection. Subsequent Inspections: Review facility file and chemical inventory information, along with the information on this <br /> form, to become familiar with potential hazardous substances and/or conditions at the facility and any control or precautionary <br /> measures that should be taken prior to conducting the inspection activity. Updatelcomplete form as needed.Sign and date below. <br /> Chemical Hazards Physical Hazards <br /> ❑ Carcinogens: I] Oxygen Deficiency: <br /> ❑ Corrosives: © Noise: <br /> © Flammables:Gasoline, Propane ❑ Excavations: <br /> © Gases: Carbon Dioxide ❑ Climbing: <br /> ❑ Metals: ❑ Explosion: <br /> ❑ Oxidizers: ❑ Heavy Equipment: <br /> ❑ PCBs; D Heat or Cold Stress: <br /> ❑ Explosives: 0 Other: Open pits,traffic,slip,trips, and falls. <br /> Biolo (cal Hazards Personal Protective Equipment <br /> ❑ Dos ❑ I Hard Hat ❑ CPC-Tyvek <br /> ❑ Snakes ® Safety Vest ❑ CPC—Other: <br /> © Insects ® Protective Boots ❑ APR Respirator <br /> ❑ Poisonous Plants ® Goggles/Glasses ❑ SCBA Respirator <br /> ❑ Other: ❑ Hearin Protection ❑ 1 Other: <br /> By signing below, I am declaring that I have reviewed the health and safety information for this facility prior to my <br /> inspection and that I have performed, and will perform during the inspection, the following actions: <br /> I have reviewed this form and the facility file for information on the business type of operation, compliance history, prior <br /> releases and response, and other health and wRq related information. <br /> I have reviewed the properties and hazards associated with the chemicals in the chemical inventory submitted by the <br /> facility. <br /> I have searched out and evaluated information on the properties of the chemicals at the facility, using the internet and <br /> other resources, for chemicals I am not familiar with at this time. <br /> I have reviewed the facility information with my supervisor if I could not determine the most appropriate health and safety <br /> precautions needed for this facility. <br /> I have gained an awareness of the potential hazards at the facility and have determined the appropriate health and safety <br /> precautions needed to perform my inspection. <br /> Before beginning the inspection, I will review the facility's health and safety information and rules with the ownerlmanager <br /> and wear the appropriate personal protective equipment. <br /> During the inspection, I will observe the labeling and condition of hazardous materials containers and conveyances, the <br /> posting of placards and warning signage, and the actions of the facility employees and guests to identify any potential <br /> unsafe conditions that may arise during the inspection. <br /> Staff Signature Date Staff Signature Date <br /> i7/Z�1 <br /> San Joaquin County Environmental Health Department; 1868 E. Hazelton Avenue; Stockton, CA 95205; 209.468.3420 <br />
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