Atch_7_Appendix_3a_-_Environmental_Checklist_B100_AHU_Plus2.pdf

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Attached to
DDJC Tracy HVAC Replacement/Renovation Federal contract opportunity
Solicitation number
W91238-18-B-0003
Issued by
Department of the Army Corps of Engineers Engineering District Sacramento

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Attachment 7: Appendix 7

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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.

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)?

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

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:

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