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CO0053618
Environmental Health - Public
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2500 – Emergency Response Program
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CO0053618
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Last modified
7/11/2023 1:53:04 PM
Creation date
7/11/2023 1:10:02 PM
Metadata
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Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0053618
PE
2546
FACILITY_NAME
LEPRINO FOODS
STREET_NUMBER
2401
Direction
N
STREET_NAME
MACARTHUR
STREET_TYPE
DR
City
TRACY
Zip
95376
APN
21307050
ENTERED_DATE
3/31/2021 12:00:00 AM
SITE_LOCATION
2401 N MACARTHUR DR
RECEIVED_DATE
3/31/2021 12:00:00 AM
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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SJGOV\bmascaro
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EHD - Public
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<br /> <br />The information completed in this section applies to the following employees who <br />will be working on site: <br /> <br />Employee Name Identification <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />3. INFORMATION PROVIDED TO CONTRACTOR <br /> <br />Process Safety Management <br />(PSM) Program Information1 <br />Provided?2 Employees <br />Are Trained?3 <br />Reviewed?4 <br /> Ammonia Hazards Summary <br /> Applicable Hazard Assessment <br />Details <br /> <br /> Applicable Process Safety <br />Information <br /> <br /> Contractor’s response and role <br />in the event of an emergency. <br /> <br /> <br />1 Elements of the Process Safety Management (PSM) Program that will be <br />reviewed with the contractor. <br /> <br />2 The contractor will initial in the block beside each checked box to certify that the <br />contractor has been provided with the indicated element of the PSM Program. <br /> <br />3The contractor will initial in the block beside each checked box to certify that the <br />contractor can provide documentation that employees have been trained in the <br />indicated PSM Program element. <br />
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