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COMPLIANCE INFO_2021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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1900 - Hazardous Materials Program
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PR0543667
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
9/15/2022 11:06:22 AM
Creation date
5/11/2021 10:28:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0543667
PE
1921
FACILITY_ID
FA0023636
FACILITY_NAME
Manteca Dialysis
STREET_NUMBER
1620
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
Ave
City
Manteca
Zip
95337
CURRENT_STATUS
01
SITE_LOCATION
1620 W Yosemite Ave
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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05/12/2021 12:18 FAX 00008/0008 <br /> CIsRS Consolidated Emergency Response/Contingency flan—Page 4 of 4 Rev,06/27/11 <br /> H. EARTHQUAKE VULNERABILITY <br /> ldemiiy areas of the 1i(cihty that are vulnerable to hazardocis 3naterials releases/spills due to earthquake-relaled motion_'These areas require immediale isolation and <br /> Inspection. <br /> VULNEIZABLE ARRAS:(Check all that apply) l LOCATIONS(c-g shop,outdoor shed,I'mensic lab) <br /> ❑x I. IIAGARDOUS MA"IITIALS/WASTE STORAGE AREA Water Storage room 112 <br /> ❑Q 2.PROUSS I.INI:S/P€PING Water room,Treatment floor,clinic 113 <br /> © 3.LABORATORY NIA 11,1 <br /> ® 4.WASP):!'I'R13AT'MI.N'h ARLA Bio hazard room door shut and locked at all times. W. <br /> Identify mechanicals stems vulnerable to releases!spills due to cartheluake-gelatedtnotio t. I"€"hese systems require immediate isolation and <br /> VULNERABLE SYSTEMS:(Check all that apply) LOCATIONS <br /> Q 1.S1It;l.VI S,CABINF.I.S AND RACKS Nurses Station ttz <br /> ❑X 2.TANKS(1 MERGE:NCY SI I(?'['(]]'f) :Water heater,softner,chlormine.RIO system Its <br /> ❑X 3.PORTABLE GAS CYLINDERS 02 tanks fJv <br /> ❑X 4.IAMEEZG[=NCYSIIUTOE,i-ANDIOR UTILITY VAI..VIr.S Gas Shut off valve outside of the building r e. <br /> ❑S( 5.SPRINK1,13 SYS'[EMS Fire department inspection t <br /> ❑ 6.STATIONARY I'IZI:SSURVl.,D CONTAINERS(e.g,Propane dispensing tank) 1112 <br /> I. EMPLOYEE TRAINING <br /> Explanation of Rcgnircrnent:E3ntployee Irai:lint;is required Im all emplovccs handling hazardous materials an(I hazardous wastes in day-to-(hiy or clean-up operations <br /> including volunteers and/or conlractors.T raining must be. <br /> • Provided within 6 montlts for new hires: <br /> • Amended as necessary prior to elutnge in process or work assignmcty; <br /> • Given upon modification to tam I:mergcney Response I Con[mgcney Plan,and updatedlref'reshed annually f'or all employees. <br /> Required content includes all of the lollossing: <br /> • Motorial Salely Data Sheets, • Communication and aurin systems. <br /> Hazard eommutncation related to health and salcty; • Personal protective equipment_ <br /> • Melhods lirr sat'e handling o1'hazardous tttbslances: • lJsc oremergcney response equipment(e_g_Pire extinguishers,respirators, <br /> • Fire hazards of materials/processes' <br /> • Conditions likely to worsen enrergcncies; • Decontamination p)]T)Mftll'M <br /> • Coordination ol'emergcncy response: • Evacuation procedures; <br /> • Notification procedures; Control and contalnmenl procedures. <br /> • A>>licable Ia\vsancl re>ttlations, IJS'I'monitoring system equipmcnt and procedures(ii'applicable). <br /> INDICATE I IOW IMILOYE .TRAINING PROGRAM IS ADMINISIT:Rl:D(Check all that apply} i <br /> x❑ 1. FORMAL.CLASSROOM; M2. VIDEOS; 0 3,SAI-TTY/T'AILGA-lT M1:1:'IINGS:. <br /> 214 S['IJ IaY GUI T}[iS/MANNALS(5pecil)): Star[.earning,Disaster Ran 12 <br /> ES. 0I111,R(SpecilV)', Mock Drills with teammates and patients <br /> u <br /> E10. N(}T APFI.I(.`AI31..T:BEC'AT1SIi FACILITY IiAS NO I:MNL,OYia�'.S <br /> Large Qnaniity Cenerator(I.Q(;)Traiairig Records: Large quantity hazardous waste generators(i e., Who generate MON than 270 ga110ns/1.000 kiingrnns of <br /> hazardous waste per month)must retain writlea documentation ol'employcc hazardous Waste management training sessions Na�hich includes: <br /> • A written outline/agenda o1'the type and amount of both intrnductcxy and continuing training that w°ih be given to persons rilling each job position having <br /> responsibility Jor the mhnagcnrcnl orhazardous wasle[c.g.,labeling nrtrtil'esling,compliance smith accuntulatiwt(title limits,etc.), <br /> • The na me,.loh Lille,and date oi'tiaining for each hazardous waste management[raining session given to tut employee rillin4 such a job position;and <br /> • A written job description for each of the above job positions that desci ibesjob dulies and lie skills,edueation,or other qualifications required of'petsonnel assigned <br /> to the position. <br /> • Current employee training records must be ielained until closure of dIC facility. <br /> • Former cm,loyce lrainin�records must be retained at least three years after termtnalron ol'em Jlo yine-nt, <br /> J. LIST Olt' ATTACHMENTS <br /> (Check one of the following) i <br /> ❑X 1. NO ATTACI[MI.;NI'S Alt(:RI:QUI RED,or' <br /> ❑2. THE FOL.LOWIN(i DOCUMENTS ARL:A'1TACIIE1): J2. <br /> K. SIGNATURE/CERTIFICATION <br /> Certirealion: Based on my inquiry of those individuals responsible for obtaining the inlormalion,1 wilily under penalty ollasj that I have personally examined and <br /> am Pamihar with the informations ttcd and believe the information is true,ace urate,and c(nnpictc,and that a cn1)y iS available cm.rite_ <br /> SIGNATURI OF OWNF.`H/OPE t f DATL,SIGNS-D ht <br /> Robert Valenzuela Jr 5/11/2021 <br /> NAME OF SIGNER(print) w2 IITIT OF SIGNER sJ <br /> (Robert Valenzuela Jr FA <br />
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