ATTACHMENT_5_-_Env_Checklist.pdf

ENVIRONMENTAL, SAFETY & INDUSTRIAL HYGIENE

CHECKLIST

Project proponent completes all sections. Please print clearly or type. Submit to Environmental, Safety & Occupational Health Division for review. Any questions Call ESOH Division Chief: 839-5537.

Section 1: General Information Project# Date:

Project Title:

Phone:

Phone:

Proponent/Department:

Project POC:

Section 2: Project Information

Planned Start Date: Planned Completion Date:

Purpose of the project (include any description of operations, functions, and activities associated with the project which will change or occur due to the project):

Attach any Statement of Work, Maps, Drawings or other relevant information.

ESOH Checklist Page 1 of 3 16 Jun 2015

Describe the location and area of the proposed project:

Section 3: Specific Project Questions (Check positive responses.)

Facility/Building demolition, renovation, alteration or retrofit?

Installation, repair or removal of fuel storage tanks or distribution facilities?

New heating units or boilers?

Emergency generators or other stationary internal combustion engines?

New sources of air emissions (e.g. paint booths, blasting operations)?

New drinking water services?

Generation or Disposal of domestic wastewater (e.g. rinsewater, washdowns, pressure washing, etc.)?

Installation or removal of potable water backflow prevention devices?

Use or storage of Hazardous materials:

Concrete?

Disposal of Solid wastes such as:

Asphalt?

Topsoil?

Electrical equipment?

Recyclable materials (e.g. steel, cardboard, wood, etc.)?

Asbestos or Asbestos containing building materials?

Disturbance or use of Hazardous substances such as:

Mercury?

PCBs?

Lead Based Paint?

Other?

Cleaners or solvents?

< 1 acre?

Hazardous material storage required?

Storage of HM more than 55 gal?

Will there be temporary or permanant storage of HM?

Potential to cause any concerns from the neighbors (e.g. dust, noise > 70dB, view)?

ESOH Checklist Page 2 of 3 16 Jun 2015

Project located in area of Land Use Controls? (See Appendix G Real Property Master Plan)

Cumulative excavation, trenching, or disturbance of soils?

> 1 acre but < 5 acres?

> 5 acres?

Environmental Requirements/ comments:

Date:

ENVIRONMENTAL, SAFETY & INDUSTRIAL HYGIENE

REQUIREMENTS

This page to be completed and returned by the Environmental, Safety & Occupational Health (ESOH) Division.

ESOH Checklist Page 3 of 3 16 Jun 2015

ESOH Officer review

Project#

Project Title:

While performing work at Defense Distribution Depot San Joaquin the contractor shall comply with all Federal, State and Local environmental protection and safety laws and regulations, the controls of this document, and all specific requirements stated elsewhere in contract specifications.

Safety & Industrial Hygiene Requirements/ comments:

Air Quality Program Comments

B-29 Breakroom Expansion

S. Gutierrez (x-4862)

1. Paint material being applied must meet San Joaquin Valley Air District Rule R4601 standards and not be thinned with VOC-containing material to exceed those standards. Paint and paint thinner containers (drums, buckets, cans, pails, trays, or other application containers) shall be closed when not in use to limit VOC emission.

2. New HVAC Appliance. Submit all new data to the Environmental Office. Include make, model, serial number, year, refrigerant type, and entire refrigerant charge after installation. All new refrigeration and air-conditioning appliances must meet the energy efficiency ratings and cooling capacity set forth by the California Energy Commission (ex: ice-machines, refrigerators, room air conditioners).

3. Off-road diesel equipment ≥25 bhp such as backhoes, track-hoes, trenchers, augers, loaders, cranes, forklifts, man-lifts, etc. must be registered with the state upon entrance to the installation and have an Equipment Identification Number (EIN) affixed. Large spark ignition forklifts >25 hp require registration and EINs as of 01 July 2017.

4. Adhere to the state's air-borne toxic control measure 5-min idle rule for on-road diesel-fueled vehicles >10,000 lbs and off-road diesel-fueled equipment.

5. Portable equipment with internal combustion engines >50 bhp must be registered with either CA State or the San Joaquin Air Pollution Control District. Maintain all applicable registration documentation upon entrance to the installation. Portable generators <50 BHP must meet CA State emissions requirements.

6. Air District Rule 4102: "A person shall not discharge from any source whatsoever such quantities of air contaminants or other materials which cause injury, detriment, nuisance or annoyance to any considerable number of persons or to the public or which endanger the comfort, repose, health or safety of any such person..."

IMPORTANT: YOU MUST CONTACT THE HW PROGRAM MANAGER, ED MCNAIR, PRIOR TO SETTING UP ANY HAZARDOUS WASTE ACCUMULATION/COLLECTION POINTS.

HW Generator Contact Information:

Edward McNair

Hazardous Material Hazardous Waste Program Manager and Hazardous Waste Manifest Certifier

Office phone number: (209) 839-5539 or 4528

Mobile phone number: (209) 507-1432

Fax number: (209) 839-4949

Email: edward.mcnair@dla.mil

Generator Manifest Information:

EPA ID:

CA4971520834

Generator’s Name and Mailing Address:

Defense Distribution Depot San Joaquin

Attn: Environmental Office, P.O. Box 960001, Bldg 235

Stockton, CA 95296-0710

Generator’s Phone: (209) 839-5539

Generator’s Site Address:

Defense Distribution Depot San Joaquin

25600 South Chrisman Road

Tracy, CA 95304

ENVIRONMENTAL, SAFETY & INDUSTRIAL HYGIENE

CHECKLIST

Project proponent completes all sections. Please print clearly or type. Submit to Environmental, Safety & Occupational Health Division for review. Any questions Call ESOH Division Chief: 839-5537.

Section 1: General Information Section 2: Project Information Purpose of the project (include any description of operations, functions, and activities associated with the project which will change or occur due to the project):

Attach any Statement of Work, Maps, Drawings or other relevant information.

ESOH Checklist Page 1 of 3 16 Jun 2015 ..\My Pictures\dlalogo.jpg Describe the location and area of the proposed project:

Section 3: Specific Project Questions (Check positive responses.)

Use or storage of Hazardous materials:

Disposal of Solid wastes such as:

Disturbance or use of Hazardous substances such as:

ESOH Checklist Page 2 of 3 16 Jun 2015 Cumulative excavation, trenching, or disturbance of soils?

..\My Pictures\dlalogo.jpg

ENVIRONMENTAL, SAFETY & INDUSTRIAL HYGIENE REQUIREMENTS

This page to be completed and returned by the Environmental, Safety & Occupational Health (ESOH)Division.

ESOH Checklist Page 3 of 3 16 Jun 2015 While performing work at Defense Distribution Depot San Joaquin the contractor shall comply with all Federal, State and Local environmental protection and safety laws and regulations, the controls of this document, and all specific requirements stated elsewhere in contract specifications.

8.2.1.4029.1.523496.503679

2. All construction equipment needs a thorough cleaning before entering DDD San Joaquin to eliminate the potential of invasive vegetation, from previous off depot work sites, migrating onto the Depot. -LB

3. For Air Quality Program comments please see attached file (select paper clip in left column). -SG

4. Removal of Hazardous Waste, Non-RCRA Hazardous Waste, Non-Regulated Hazardous Waste and Universal Waste: All Manifest, Non-Hazardous Waste Manifests, Special Waste Manifests, Straight Bill of Ladings will be signed by Environmental Office (DS-FJEE) personnel only; must distribute all Hazardous Waste Manifest through the Environmental Office (Ed McNair @ 209-839-5539) for Generator signature; provide advance copy of Manifest 5 days prior to hazardous waste shipment/pick up date. -EM

5. Package, mark, label and store hazardous waste in accordance with federal, state and local regulatory requirements; must coordinate hazardous waste accumulation point setup with the Environmental Office (Ed McNair @ 209-839-5539). -EM

6. Store hazardous material in accordance with state and federal safety and environmental regulatory requirements.

7. Maintain a hazardous material inventory list; ensure SDSs are available. -EM

8. Must refer to Generator's information contained in this package (select paper clip in left column). –EM

9. Coordinate with Recycling Coordinator for the proper recycling of recyclable materials. -EM

10. There are no concerns from an Installation Restoration perspective. JP

11. No Natural/cultural issues noted. JP

12. No water quality issues noted. JP

13. This action is Is categorically excluded under NEPA in accordance with the provisions of Categorical Exclusion (CX) as listed in 32CFR Part 651 Appendix B section II (g)(1). JP

2) Proper PPE must be worn at all times. KEM

3) GFCIs must be used for all power tools/equipment. KEM

4) Contact fire department to obtain hot work permit for if any grinding/welding operations are necessary. KEM

5) Submit Safety Data sheets for any chemicals/paints/solvents that will be used during this project. KEM

6) The requirements of NFPA 70E must be followed for all electrical work, to include arc flash PPE, verifying, and Lock Out/Tag Out. KEM