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0 1 <br /> ENVIRONMENTAL !IEALTH'%EPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna` Heran,R.E.H.S. Carl Bor man,R.E.H.S. <br /> Director 304 East Weber Avenue, Third Floor g <br /> N '! AlAI Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins, s.,R.D.I, <br /> Douglas W.Wilson,R.E.H.S. <br /> Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Cotulla,R.E.H.S.. <br /> Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN � ---- .-- <br /> 1 <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Independent Trucking Services 1. Chemicals Hazards <br /> Address: 1145 W Charter Way,Stockton - ®Carcinogens: <br /> Contact Person:Dave Carmichael Phone No:109)462-6009 []Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:January 2$ 2004 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Ceases: <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 Barings/Monitoring Wells. <br /> ®Hazardous Waste inspection ❑Sampling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. 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 Gas/Oxygen Meter. <br /> Other: — — <br /> ❑ Detector Tubes(Specify). <br /> ❑ Photo ionization Detector. <br /> 4. Type of Operation:Truck Repair <br /> ❑Organic Vapor Analyzer, <br /> ❑Other,specify. <br /> 5. Release History: <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <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 /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> ❑ Hard Hat. <br /> 6. Potential Health and Safety <br /> ®Safety Glasseslgoggles. <br /> Physical Concerns:(check all that apply&describe) <br /> �Steel toed/shank shoes or boots. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) ❑Flame retardant coveralls. <br /> ®Noise Sources: EQUIPMENT Hearing protection. <br /> ❑Oxygen Deficiency: ❑Tyvek <br /> Excavation:(falls,trips,slipping,cave-ins): ❑Respirator: ❑APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/P cartridge: <br /> etc..): <br /> �Safety vest. <br /> ❑Confined space entry:(explosions): <br /> El <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 b ' Fate: C U <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): PIan Approved by: Date: <br /> $. Narrative(provide all information which could impact'Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN <br /> EH 23081(12/17/2002) <br />