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COMPLIANCE INFO_PRE 2019
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PR0513485
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
3/8/2019 10:52:14 AM
Creation date
6/12/2018 8:58:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0513485
PE
1919
FACILITY_ID
FA0002462
FACILITY_NAME
EL POLLO LOCO #3307
STREET_NUMBER
678
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
14129003
CURRENT_STATUS
01
SITE_LOCATION
678 N WILSON WAY STE 3
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
JCastaneda
Supplemental fields
FilePath
\MIGRATIONS\W\WILSON\678\PR0513485\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
10/21/2015 3:42:55 PM
QuestysRecordID
2895511
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Pre-Inspection <br /> Health and Safety Assessment <br /> Facility Name: ` �G\\Q \_ O C.OA 3G7 71-- FAA FAOO 024-6; <br /> Location: �Q� N \A1,\Son Woiv6T0CKT0N, CA PR#: PROS <br /> Business Type: ` PC-AGlcy��Initial) 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.Update/complete form as needed.Sign and date below. <br /> Chemical Hazards Physical Hazards <br /> ❑ Carcinogens: ❑ Oxygen Deficiency: <br /> ❑ Corrosives: ❑ Noise: <br /> ❑ Flammables: ❑ Excavations: <br /> Gases: '2/ ❑ Climbing: <br /> ❑ Metals: ❑ Explosion: <br /> ❑ Oxidizers: ❑ Heavy Equipment: <br /> ❑ PCBs: ❑ Heat or Cold Stress: <br /> ❑ Explosives: ❑ 1 Other: <br /> Biolo ical Hazards Personal Protective E ui ment <br /> ❑ Dos ® Hard Hat ❑ CPC-Tyvek <br /> ❑ Snakes ® Safety Vest ❑ CPC-Other: <br /> ❑ Insects -0 Protective Boots ❑ APR Respirator <br /> ❑ Poisonous Plants 0 Goad s/Glasses ❑ SCBA Respirator <br /> ❑ Other: ® Hearing 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 during the ins ection. <br /> Staff Signature Date Staff Signature Date <br /> San Joaquin County Environmental Health Department;1868 E.Hazefton Avenue;Stockton,CA 95205;209.468.3420 <br /> EHD 48-0642-2013 Pre-Inspection Health&Safety Assessment <br />
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