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so 40 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PARTI PART II. <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: Independent Trucking I. Chemicals Hazards <br /> Address: 1 145 W.Charter Way,Stockton <br /> Carcinogens:used oil <br /> Contact Person:David Carmichael Phone No:466-5192 ❑Corrosives: <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection:January 2010 ❑ Explosives: <br /> ❑Flamtnables: <br /> 2. Description and brief narrative of inspection activity: ❑ htorganic Gases: <br /> ❑New UST installation.. ❑UAR Investigation. ❑Metals: <br /> ❑Tank Closure in Place.. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑ PCB's: <br /> ❑ Installation of Borings/Monitoring Wells. <br /> Hazardous waste inspection ❑ Sampling PART III <br /> ❑Tiered Permitting inspection <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3. Specific Site Information: <br /> Tank No.: Tank Capacity: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible GaslOxygen Meter. <br /> Other: <br /> ❑Detector Tubes(specify). <br /> 4. Type of Operation:Truck Maintenance ❑Photo ionization Detector, <br /> ❑Organic Vapor Analyzer. <br /> C]Other,specify. <br /> 5. Release History: <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Evidence of leaks 1 soil contamination: El YES F1 NO <br /> Documented Groundwater contamination: ❑YES ❑NO <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> ❑ Hard Hat. <br /> 6. Potential Health and Safety <br /> Physical Concerns:(check all that apply&describe) ®Safety ed/Glashank lice s. <br /> ®Steel toed/shank shoes or boots. <br /> ❑ Heat or Cold Stress: °F(high ambient temp.) <br /> ❑Flame retardant coveralls. <br /> ❑Noise Sources: <br /> Oxygen Deficiency: Hearing protection. <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins); <br /> ❑Respirator: ❑APR ❑SCI3A <br /> C]Handling and Transfer of a Hazardous Substance:(tire,explosions, <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ❑safety vest. <br /> ❑ Heavy equipment(physical injury&trauma resulting from moving ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by:Ray von Flue Date: 12123109 <br /> ❑Snakes ❑ Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <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(02119103) <br />