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COMPLIANCE INFO_PRE 2019
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PR0540599
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
1/8/2019 3:05:31 PM
Creation date
6/12/2018 8:41:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0540599
PE
1920
FACILITY_ID
FA0015270
FACILITY_NAME
GILL TIRE SHOP
STREET_NUMBER
4611
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95210
APN
10437013
CURRENT_STATUS
01
SITE_LOCATION
4611 WEST LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
EJimenez
Supplemental fields
FilePath
\MIGRATIONS\W\WEST\4611\PR0540599\COMPLIANCE INFO .PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
6/29/2016 11:30:14 PM
QuestysRecordID
3133928
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Pre-inspection <br /> Health and Safety Assessment <br /> FacilityName: Gill Tire Shop FA#: FA0015270 <br /> Location: 4611 West Ln Stockton CA 95210 PR##: PR0540599 <br /> BusinessT e: Auto Repair <br /> Initiall Com leted B Haza Saeed Date: Nov 25 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. Subseguent 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. Update/complete form as needed.Sign and date below. <br /> Chemical Hazards �� o. Ph sica—azar s <br /> ❑ Carcino ens: ❑ Oxygen Deficiency: <br /> ❑ Corrosives: ❑ Noise: <br /> ❑ Flammables: ❑ Excavations: <br /> ❑ Gases: ❑ Climbing: <br /> ❑ Metals: ❑ Explosion: <br /> ❑ Oxidizers: ❑ Heavy Equipment: <br /> ❑ PCBs: ❑ Heat or Cold Stress: <br /> ❑ Ex losives: ❑ 1 Other: <br /> Bio lo ical Hazards Personal Protective Equipment <br /> ❑ Do s ❑ Hard Hat ❑ CPC-T vek <br /> ❑ Snakes ® Safety Vest ❑ CPC–Other: <br /> ❑ Insects ® Protective Boots ❑ APR Respirator <br /> ❑ Poisonous Plants ® Goggles/Glasses ❑ SCBA Respirator <br /> ❑ Other: ❑ Hearina Protection ❑ 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 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 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 Burin the ins ection. <br /> Staff Signature Date Staff Signature Date <br /> 4 C <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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