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0 <br /> ENVIRONMENTAL HEALTH EPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Donna K.Heran,R.E.H.S. Unit Supervisors <br /> ter' 304 East Weber Avenue, Third Floor Carl Borgtnan,R.E.H.S. <br /> 4F- Director <br /> •{ Al Olsen,R.E.H.S. Stockton California 95202-27fl8 Mike Huggins,R.E.H.S.,R.D.I. <br /> Douglas W.Wilson,R.E.H.S. <br /> c4cr a�P .Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> > © Laurie A.Cotulla,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I FART 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 <br /> Carcinogens: <br /> Contact Person:Dave Carmichael Phone No:(209)462-6009 ❑Corrosives <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigation/inspection:January 28,2004 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑ Inorganic 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 /> 0 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 /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Appliance Recycler ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> S. 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 ND <br /> Hard Hat. <br /> 6. Potential Health and Safety <br /> Physical Concerns:(check all that apply&describe) 0 Safety ed/Glashank hoes. <br /> ®Steel toed/shank shoes or boats. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) <br /> ❑Flame retardant coveralls. <br /> ®Noise Sources: EQUIPMENT <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ❑Tyyek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator: [_1 APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): Z 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 6?0. Date: <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.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />