Appendix_10_-_Environmental_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:

P.2016.01424 Jul 27, 2016

Repair Floors, Warehouses 15, 17, 18 and 19

2-4524

2-4524

DS-FJIF/Facilities & Equipment Engineering Branch

Richard Horiuchi

January 2017 December 2017

The purpose of this project is to repair the floors in warehouses so that the uneven and cracked floor surfaces are not tripping hazards to employees, and the undersides of forklifts do not scrape the floors and damage the forklifts. Floor joints will be repaired, damaged concrete sections will be replaced and floor coatings will be replaced.

The Statement of Work and warehouse location map drawing are attached. Detailed drawings will be prepared by the Army Corps of Engineers after funds are provided.

Project locations are inside Warehouses 15, 17, 18 and 19.

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:

1. Best management practice read and adhere to Air District Rule 8010 such as to limiting fugitive dust for control of particulate matter (PM-10) throughout all phases of the project. -LB

2. Best management practice read and adhere to California Highway Patrol Vehicle Code Section 23114 transportation of "aggregate material" from DDD San Joaquin to final destination for disposal. -LB

3. Best management practice for Pest Management for all equipment to be thoroughly cleaned before entering DDD San Joaquin to eliminate the potential of invasive vegetation from being migrated onto the Depot. -LB

4. No concerns from an Installation Restoration perspective. JP

5. No NEPA and/or Natural/cultural issues noted. JP

6. No water quality issues noted. JP

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

EM

8. Maintain a hazardous material inventory list; ensure SDSs are available. –EM

9. Contractor must adhere to the attached General Environmental Controls. –EM

8/8/2016

MAHAN.BRENDA.S.1231676844

Digitally signed by

MAHAN.BRENDA.S.1231676844

Date: 2016.08.08 14:08:38 -07'00'

P.2016.01424

Repair Floors, Warehouses 15, 17, 18 and 19

1) Submit Site Specific Safety and Health Plan. KEM

2) Submit Injury Illness and Prevention Plan. KEM

3) Submit OSHA 300 log if has 10 or More Employees. KEM

4) Submit Safety Data S for any chemicals used for the project. KEM

5) Delineate work site to prevent depot personnel from entering the hazardous construction areas. KEM

6) Obtain hot work permit from Fire Department for grinding operation. KEM

7) Have a Respiratory protection plan in place. KEM

8) During concrete sawing use wet methods to minimize risk associated with crystalline silica. KEM

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:

P.2015.01559 Sep 2, 2015

Repair Floors, Warehouses 20, 21, 22 and 28

2-4524

2-4524

DS-FJIF/Facilities & Equipment Engineering Branch

Richard Horiuchi

Jan 25, 2016 Jul 29, 2016

The purpose of this project is to repair the floors in warehouses so that the uneven and cracked floor surfaces are not tripping hazards to employees, and the undersides of forklifts do not scrape the floors and damage the forklifts. Floor joints will be repaired, damaged concrete sections will be replaced and floor coatings will be replaced.

The Statement of Work and drawings are attached.

Project locations are inside Warehouses 20, 21, 22 and 28.

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:

1. No water quality, NEPA and/or Natural/cultural issues noted. JP

2. Provide inventory of chemicals that will be used on the installation. LT

3. No concerns from an Installation Restoration perspective. MLB

4. If any friable asbestos is found during removal/replacement, it must be managed/disposed as a hazardous waste.

All hazardous waste manifests must be reviewed and certified by the environmental office. EM

5. Due to air quality concerns the grinding, demolition and removal of ACM concrete is required to keep emissions to a minimum through the use of vacuums or wetted means. EM

6. Submit an Asbestos Notification to the San Joaquin Valley Air Pollution Control District prior to any ACM disturbances/repairs. EM

Sep 11, 2015

THORNTON.CHRIS.J.115911387

Digitally signed by THORNTON.CHRIS.J.1159113872 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=DLA, cn=THORNTON.CHRIS.J.1159113872 Date: 2015.09.11 08:09:57 -07'00'

P.2015.01559

Repair Floors, Warehouses 20, 21, 22 and 28

Bulk samples must be collected and submitted to a laboratory for analysis of asbestos for the concrete and associated expansion joint compound prior to disturbing the flooring materials.

Robert Miller, CIH, CAC