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EHD Program Facility Records by Street Name
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1900 - Hazardous Materials Program
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PR0521167
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COMPLIANCE INFO
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Last modified
12/5/2018 3:31:38 PM
Creation date
6/10/2018 12:41:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0521167
PE
1919
FACILITY_ID
FA0001792
FACILITY_NAME
MCDONALDS 25768
STREET_NUMBER
2505
Direction
W
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
Zip
95207
APN
11222035
CURRENT_STATUS
01
SITE_LOCATION
2505 W MARCH LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
JCastaneda
Supplemental fields
FilePath
\MIGRATIONS\M\MARCH\2505\PR0521167\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
5/27/2016 4:38:19 PM
QuestysRecordID
3060709
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Pre-Inspection <br /> * Health and Safety Assessment <br /> Facility Name: �\(� ('do�Q \ c�S �.r� FA*. FA000 1�G <br /> Location: 2,505 1 �IQt( cC1 1 L pl STOCKTON, CA PR#: PR05 2 t t <br /> Business Type: F F Sti scop Ly <br /> Initially Completed By: HAZA SAEED Date: _ \ <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: ❑ Oxygen Deficiency: <br /> ❑ Corrosives: ❑ Noise: <br /> ❑ Flammables: El Excavations: <br /> Gases: C� Z ❑ Climbing: <br /> ❑ Metals: ❑ Explosion: <br /> ElOxidizers: ❑ Heavy Equipment: <br /> ❑ PCBs: ❑ Heat or Cold Stress: <br /> ❑ Explosives: ❑ 1 Other: <br /> Biolo ical Hazards Personal Protective Equipment <br /> ❑ Dos 0 Hard Hat 111 CPC-T vek <br /> ❑ Snakes 0 Safety Vest 10 1 CPC—Other: <br /> ❑ Insects 14 Protective Boots ❑ APR Respirator <br /> ❑ Poisonous Plants 0 GoggIes/Glasses ❑ SCBA Respirator <br /> ❑ Other: ® Hearing Protection 1 ❑ 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 /> 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 safety 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 owner/manager <br /> and wear theappropriate ersonal 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 ins ection. <br /> Staff Signature Date Staff Signature Date <br /> San Joaquin County Environmental Health Department;1868 E.Hazelton Avenue;Stockton,CA 95205;209.468.3420 <br /> EHD 48-06-12-2013 Pre-Inspection Health&Safety Assessment <br />
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