Laserfiche WebLink
pP.(ZUIN. <br />ENVIROIR4ENTAL HEALTIXEPARTMENT <br />SAN JOAQUIN COUNT'S <br />c�<iFOR�'vP • Donna K. Heran, R.E.H.S.�fL Program Coordinators <br />Director T+ird Flom <br />Carl Borgman, R.E.H.S. <br />Laurie A. Cotulla, R.E.H.S. <br />Stockton' California 95205 Mike Huggins, R.E.H.S., R.D.I. <br />R.E.H.S <br />, . <br />Foley, <br />L. Assistant Director Telephone: (209) 468-3420 MargaretKasey L. Foley, R.E.H. <br />S. <br />Fax: (209),464-0138 Robert McClellon, R.E.H.S. <br />Web: www.sjgov.org/ehd Jeff Carruesco, R.E.H.S. <br />SITE HEALTH & SAFETY PLAN <br />PART <br />GENERAL SITE INFORMATION <br />1. Site Name: .kc4,_ k 414! <br />Address: W I 1Nt%16772/fit AVRAJGtr, i R 119,4 <br />Contact Person: b4VN 1r Phone No: OPJ4 ,S5r9 ^ 611f <br />Sweeps Number: <br />Proposed Date of investigation/inspection:� U �l % <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation.. <br />❑ UAR Investigation. <br />❑ Tank Closure in Place.. <br />❑ Tank/Pipe Repair. <br />❑ Tank/Pipe Removal. <br />❑ Re -excavation. <br />.❑ Installation of Borings / Monitoring Wells. <br />Tazardous waste inspection <br />[:1Sampling <br />0 iered Permitting inspection <br />3. Specific Site Information: <br />® Steel toed/shank shoes or boots. <br />Tank No.: <br />Tank Capacity: <br />Tank Content: Tank <br />Other: <br />4. Type of Operation: MeS L1 1✓a <br />I✓l&W-fr au ' AZZ4M1 eta �t <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 />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />C Carcinogens: <br />® Corrosives: <br />Dusts: <br />Explosives: <br />i� Flamrnables: <br />❑ Inorganic Gases: <br />❑ Metals: <br />❑ Oxidizers: <br />❑ PCB's: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. 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 />If monitoring instruments are not used, rationale or activity / area restrictions: <br />EH 23081 (02/19/03) <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ <br />C ® D <br />6. Potential Health and Safety <br />® Hard Hat. <br />Physical Concerns: (check all that apply & describe) <br />® Safety Glasses/goggles. <br />❑ Heat or Cold Stress: °F (high ambient ternp.) <br />® Steel toed/shank shoes or boots. <br />❑ Noise Sources: <br />❑ Flarne retardant coveralls. <br />❑ Oxygen Deficiency: <br />® Hearing protection. <br />❑ Excavation: (falls, trips, slipping, cave-ins): <br />El Tyvek. <br />Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />❑ Respirator: El APR ❑ SCBA <br />etc..): <br />A/P cartridge: <br />❑ Confined space entry: (explosions): <br />® Safety vest. <br />Heavy equipment (physical injury & trauma resulting from moving <br />El Two-way cormnunication. <br />equipment): <br />❑ Other, specify: <br />PART IV - PLAN APPROVAL <br />7. Anticipated Biological Hazards: <br />Plan Prepared by: M Naidu <br />Date: % t 2 - <br />❑ Snakes 3 Insects ❑ Rodents ❑ Poisonous Plants <br />El <br />❑ Other/Unknown (specify):I'1 <br />Plan Approved by: L) <br />Date: I/ <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 (02/19/03) <br />