Appendix_4B-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:

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:

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

The Statement of Work and preliminary drawings are attached.

2. 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

3. Best management practice all equipment, that will be used by contractor, prior to entering DDD San Joaquin will be registered in the California Portable Equipment Registration Program (PERP) and the Diesel Off-Road On-Line Reporting System (DOORS) Programs.

4. All equipment that fall into the DOORS program will have Equipment Identification Numbers attached by contractor prior to entering DDD San Joaquin. -LB

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

6. No hazardous material nor hazardous waste concerns. -EM

2. Submit Injury Illness and Prevention Plan. KS

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

4. Submit Safety Data Sheets for any chemicals that will be used during the project. KS

5. Delineate work site to keep personnel form entering hazardous construction areas. KS

6. Adhere to NFPA 70E for electrical work if any (LOTO, PPE, ETC.) KS