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zQ�Ru!11._ c <br />�< ENVIRONMENTAL HEALTH DEPARTMENT <br />... SAN JOAQUIN COUNTY program Coordinators <br />�cic6aN Donna IC Heran, RE.H.S. <br />1868 E. Hazelton Ave., Stockton, California 95205 Kasey L. Foley, R.E.H.S. <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Robert McClellon, R.E.H.S. <br />Jeff Carruesco, R.E.H.S. <br />Web: www.sjgov.org/ehd Linda Turkatte, R.E.H.S. <br />SITE HEALTH & SAFETY PLAN <br />PART <br />GENERAL SITE INFORMATION <br />L Site Name: Tuff Shed <br />Address: 2829 S Hwy 99 Stockton 95205_ <br />Contact Person: Brad <br />Phone N: 216-7786 <br />Proposed Date of investigation/inspection: <br />Description and brief narrative of inspection activity: <br />❑ New UST installation ❑ UAR Investigation <br />❑ Tank Closure in Place ❑ Tank/Pipe Repair <br />❑ Tank/Pipe Removal ❑ Re -excavation <br />❑ Sampling ❑ Boring/Monitoring Well installation <br />❑ Hazardous Waste inspection ❑ Tiered Permitting inspection <br />® Hazardous Materials Business Plan <br />3, Specific Site Information: <br />Tank No.: Tank <br />Tank Content: Tank <br />Other: Not applicable <br />4. Type of Operation: <br />5. Release History: <br />Evidence of leaks/soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. Potential Health & Safety Physical Concerns: (check all that apply & <br />describe) <br />❑ Heat or Cold Stress: °F (high ambient temp.) <br />❑ Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation (falls, trips, slipping, cave-ins): <br />❑ Handling and Transfer of a Hazardous Substance (fire, explosions, etc.):, <br />❑ Confined space entry (explosions): <br />❑ Heavy equipment (physical injury & trauma resulting from moving <br />® Other (specify): <br />Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents ❑ Poisonous Plants <br />® Other/Unknown (specify): <br />8. Narrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.): <br />EH 23081 (3/5/2013) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />L Chemicals Hazards <br />❑ Carcinogens:_ <br />❑ Corrosives:_ <br />❑ Dusts: <br />❑ Explosives:_ <br />❑ Flammables:_ <br />❑ Inorganic Gase: <br />❑ Metals: <br />❑ Oxidizers:_ <br />❑ PCBs: <br />® Other: Unknow <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />L Monitoring Equipment (Note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided): <br />❑ Combustible Gas/Oxygen Meter <br />❑ Detector Tubes (specify): <br />❑ Photo ionization Detector <br />❑ Organic Vapor Analyzer <br />❑ Other (specify): <br />® None (see below) <br />If monitoring instruments are not used, rationale or activity/area restrictions: <br />This inspection does not require entry in to hazardous atmospheres <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C 19 D <br />❑ Hard Hat <br />❑ Safety Glasses/Goggles <br />® Steel toed/shank shoes or boots <br />❑ Flame retardant coveralls <br />❑ Hearing protection <br />❑ Tyvek <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P Cartridge: <br />❑ Safety vest <br />❑ Two-way communication <br />N Other (specify): Other safety equipment as dictated by business/conditions.- <br />PART IV <br />PLAN APPROVAL <br />Plan Prepared by: Lowell Allen [EM Date: <br />Plan Approved by: J -W Date: 3, <br />