COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Pine-li nslaectioen Health and Safety Assessment 1/ n nn � ^ � FAP arca I Facility Name• VU -1 L �/yl�'�j("� ' ,VC�lnk Lo J--(1C Location �o�OI Q F ��t^ to trte r 1 n 4, PR*'D53cl zla 3 BusinessType: ✓tock Initially Com feted B : Date: Instructions: Fill out this form as best as possible befo the initial inspection and complete the remaining Information during or after the inspection. Subsequent Inspections: Review facility file and chemical inventory information,along with the information on this form, to become familiar with potential hazardous substances andfor conditions at the facility and any control or precautionary measures that should betaken odor to conducting the inspection acfrvity.Updatefcomplete form as needed.Sign and date below. Chemical Hazards I Physical Hazards ❑ Carcino ens: ❑ Oxy en Deficient ❑ Corrosives: ❑ Noise: Flammables: ❑ Excavations: ❑ Gases: ❑ Climbin : ❑ Metals: ❑ Ex loslon: Cl Oxidizers: ❑ Heav E ui ment: ❑ PCBs: - ❑ Heat or Cold Stress: ❑ E losives: - ❑ I Other: Biological Hazards Personal Protective Equipment ❑ Do s 9? Hard Hat ' ❑ CPC-T ek ❑ Snakes W Safety Vest ❑ CPC—Other: ❑ Insects W Protective Boots ❑ APR Respirator ❑ Poisonous Plants Go IeslGlasses . ❑ SCBA Respirator ❑ Other: ❑ Hearin Protection ❑ Other: By signing below,I am declaring that I have reviewed the health and safety information for this facility prior to my Inspection and that I have performed, and will perform during the inspection, the following actions: I have reviewed this form and the facility file for information on the business type of operation,compliance history,prior releases and res ons-,and other health and safety related information. I have reviewed the properties and hazards associated with the chemicals in the chemical inventory submitted by the facility. have searched out and evaluated information on the properties of the chemicals at the facility,using the Internet and other resources,for chemicals I am not familiar with at this time. I have reviewed the facility information with my supervisor if I could not determine the most appropriate health and safety precautions needed for this facility. 1 have gained an awareness of the potential hazards at the facility and have determined the appropriate health and safety precautions needed to perform my inspection. Before beginning the inspection,I will reviewthe facility's health and safety information and rules with the ownerfmanager and wear thea ropriate ersonal protective a uipment. During the inspection,I will observe the labeling and condition of hazardous materials containers and conveyances,the posting of placards and warning signage,and the actions of the facility employees and guests to identify any potential unsafe conditions that may arise during the inspection. Staff Signature Date Staff Signature Date - San Joaquin County Environmental Health Depadment;U68 E.Hazelton Avenue;Stockton,CA 95205;209.468,3420 SRI AG nC 17 OMa